1. Challenges and healthy ageing: the role of resilience across the life course Biological resilience and cognitive function in the over 65s

2. Definitions Resilience – Buffer in disease risk exposure brought about by high health assets (Harrison et al 2004) Disease risk exposure – Failing cognitive function High health assets – High levels of vitamin B 12

3. The study To explore the association between vitamin B 12 and cognition In a sample from Gwynedd CFAS cohort 84 community dwelling non demented people aged 65 and over

4. Background Vitamin B 12 is the coenzyme for the conversion of – MMA, homocysteine. Low levels of B 12 lead to – MMA, Folate trapped as methyl-THF Raised MMA – Associated with cognitive performance (Garcia 2004; Lewerin 2005; Lewis 2005)

5. The data Cognition – MMSE – CAMCOG – language comprehension, language expression, remote memory, recent memory, constructional praxis, ideational praxis, total praxis, abstraction, perception From serum – vitamin B 12, HoloTC, creatinine, folate, MMA Age, sex, education

6. Method Model variability in – MMSE score – CAMCOG score – scores on cognitive domains Using age, sex, education, creatinine, folate and in turn – Vitamin B 12, holoTC or MMA

7. Descriptive data Age7869 – 93 Education97 – 21 MMSE2618 – 30 CAMCOG8956 – 103

8. Descriptive data B 12 14611-48617 (20%) HoloTC599-16322 (26%) Folate10.92.7-45 4 (5%) Creatinine9849-15415 (18%) MMA0.440.08-1.8542 (50%)

9. Results - MMSE and CAMCOG MMSE – Age [-0.12(0.05)] – MMA [-2.42(1.02)] CAMCOG – Age [-0.63(0.18)]

10. Results - Cognitive domains AbstractionAge Perception Age Recent memoryAge Remote memoryAgeEd Folate Constructional praxis Folate Ideational praxisFolateMMA Total praxis FolateMMA Language expression MMA Lang comprehensionMMA

11. Cognitive function, social activity and spousal bereavement Challenges and healthy ageing: the role of resilience across the life course

12. Definitions Resilience – Buffer in disease risk exposure brought about by high health assets (Harrison et al 2004) Disease risk exposure – Failing cognitive function in the face of spousal bereavement High health assets – High levels of social activity

13. The study To explore whether spousal loss influences both cognitive function and social activity and whether their relationship is changed as a consequence?

14. Literature Bereavement and social activity – Burton 2006; Bennett 2005; Utz 2002; Bereavement and cognitive function – Xavier 2002; Grimby 1995;

15. The data Taken from 5 centres of MRC CFAS Two groups at time 2 – still married (n=3481) and newly widowed (n=257) Variables – Age, gender, social activity T1 and T2, MMSE T1 and T2

16. Pr. ASSESSMENT N=2640 FOLLOW UP N=920 Inc. ASSESSMENT N=1463 INCIDENCE SCREEN N=7175 SCREEN AND ASSESSMENT N=1651 PREVALENCE SCREEN N=13004 MRC CFAS study design FOLLOW UP N=920 SCREEN AND ASSESSMENT N=1743SCREEN AND ASSESSMENT N= SCREEN AND ASSESSMENT N~5000

17. Respondent’s characteristics MarriedNewly widowed Age at t 1 72.4 yrs74.5 yrs Female 40%65% MMSE t 1 27.526.9 MMSE t 2 26.926.1 Change MMSE-0.6-0.8 Satis.social activ.75%70%

18. Age Gender MMSE t2 MMSE t1 Social Activity t2 Social Activity t1

19. Age Gender MMSE t2 MMSE t1 Social Activity t2 Social Activity t1

20. Age Gender MMSE t2 MMSE t1 Social Activity t2 Social Activity t1 = NW -.01 (ns) M.013 = = = NW.21 M.41 = = = NW-.17 M-.12

21. Relationships unaffected by marital status Age predicts MMSEt 2, SAt 1, SAt 2 (independent of SAt 1 ) Gender predicts MMSEt 1, SAt 1 MMSEt 1 predicts MMSEt 2 SAt 1 predicts MMSEt 2

22. Relationships affected by marital status SAt 1 predicts SAt 2 - satisfaction with social activities remains the same but is more likely to do so if married. Age predicts MMSEt 1 - older people have lower cognitive function especially if newly widowed. MMSEt 1 predicts SAt 2 – cognitive function weakly predicts satisfaction with social activity if married but not if newly widowed.

23. Conclusions Spousal bereavement – Modifies satisfaction with social activities – Intensifies the effect of age on cognitive function – and the impact is during the transition phase not post-widowhood.

24. Overall In the face of assaults to good cognitive function in the over 65s resilient individuals – Have high levels of vitamin B 12 – Are satisfied with their level of social activity