Health Literacy and Cognitive Function among Middle-Aged Adults: The MidCog Study

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We will expand our active study of older adults and recruit a parallel cohort of middle age adults to begin novel investigations of less-studied, modifiable, midlife determinants of later life cognitive impairment. Studying cognitive changes in middle adulthood (ages 40-64) could elucidate modifiable factors that might prevent later life cognitive impairment. Very few cognitive aging studies to date include this age group. Those that have are limited to small or condition-specific samples, cross-sectional analyses or cohort studies with few follow-up periods, abbreviated cognitive tests, limited covariates, or a lack of diversity in study samples. But many known factors for cognitive impairment manifest in middle age: 1) chronic conditions that often are delayed in their detection, or inadequately managed due to poor treatment adherence; 2) undetected or uncorrected sensory impairments; 3) entrenched lifestyle behaviors; and 4) common biological and psychosocial stressors. Thus, greater attention is being paid to proper health self-management and routine healthcare engagement in midlife. Yet many U.S. adults may reach middle age lacking proficient `health literacy'; the capacity to gather accurate self-care knowledge, make informed health decisions, enact recommended behaviors and appropriately use health services. Health literacy is modifiable, by enhancing health knowledge and self-care skills, but also by reducing treatment burden imparted by health systems. Promoting health literacy could improve self-management, increase routine healthcare use and modify lifestyle; thus reducing risk of later life impairment. Since 2007, we have examined how cognitive decline affects health literacy, self-management skills, and health (R01AG030611) among older adults. Our active `LitCog' study has shown how cognitive function affects health literacy, self-management, and health in older age. But in midlife, limited health literacy and self-management skills may lead to unhealthy lifestyle, chronic disease, and poorly managed health due to infrequent healthcare use and poor treatment adherence - increasing risk of cognitive impairment. Our 2020 LitCog renewal adds a 5th, 6th follow-up interview. We seek to initiate a parallel, middle age cohort (`MidCog'; ages 40-64; N=1200), conducting the first two assessments 2.5 years apart. Our specific aims are to: 1) Characterize health literacy, self-management skills, and cognitive function in detail among middle age adults; 2) Evaluate associations between health literacy, self-management skills, health behaviors, healthcare use, health status, chronic disease outcomes and cognitive function over time; 3) Investigate whether certain modifiable, psychosocial, midlife factors moderate associations between health literacy, self-management skills, health status and cognition; and 4) Using MidCog + LitCog data, explore associations between age, health literacy, self-management skills, health status, presence & management of chronic disease, and cognitive function among adults ages 40 to 90. We will complement existing midlife research & inform health system strategies to preserve cognitive function.