Molly Maxfield

INTRODUCTION: Childhood maltreatment is associated with increased risk for cognitive impairment. We examined whether psychosocial factors (socioeconomic status, education, depression, social support, social isolation) explained this relationship. METHODS: In a prospective longitudinal study, children with documented histories of maltreatment and demographically matched controls were followed for over 30 years. Psychosocial variables were assessed in young adulthood ( N  = 1196, M _age = 29), and cognitive impairment no dementia (CIND) was assessed in late midlife ( N  = 447, M _age = 59.4). Analyses included logistic regression and structural equation modeling. RESULTS: Childhood maltreatment and higher levels of social isolation increased risk for CIND, whereas higher socioeconomic status (SES), education, and depression symptoms in young adulthood decreased risk for CIND. Social support was not associated with CIND. Education and SES partially mediated the relationship between childhood maltreatment and CIND. DISCUSSION: Increasing educational opportunities for maltreated children may improve SES and reduce risk for CIND and dementia.

Background: Engaging in regular aerobic physical activity (PA) during midlife is associated with reduced risk for Alzheimer disease and related dementias. Yet, most midlife adults fail to meet national PA guidelines. Goal setting is a commonly used behavior change technique to increase PA, but limited empirical evidence exists regarding whether certain types of goal setting are more effective than others. This study served as an initial step toward understanding how different goal-setting strategies may enhance PA and promote adherence to national PA guidelines among insufficiently active midlife adults with obesity. Objective: This study aimed to establish the feasibility and acceptability of a 4-arm mechanistic trial design comparing 3 different PA goal-setting techniques with a non–goal-setting comparison condition. Methods: This study was a 6-month stage IA mechanistic trial (based on National Institute on Aging’s Stage Model) that randomized insufficiently active midlife adults with obesity to 1 of 4 study groups: (1) Static Goal-Setting Group (weekly moderate to vigorous physical activity [MVPA] goal of 150 minutes), (2) Self-Selected Goal-Setting Group (participants self-selected a weekly MVPA goal), (3) Incremental Goal-Setting Group (weekly MVPA goal 20% greater than the previous week), and (4) Non–Goal-Setting Comparison Group (encouraged to increase MVPA without specific reference to a weekly goal). All participants (n=24) received a standardized, Social Cognitive Theory–based PA promotion intervention, which consisted of structured action planning sessions and a Fitbit activity monitor for self-monitoring of MVPA. The only difference across study groups was the goal-setting technique implemented. Primary outcomes included feasibility of study implementation, as assessed by recruitment, retention, and engagement rates; the ability to deliver the intervention as planned and collect outcomes necessary for evaluating the effects of different goal-setting techniques in a subsequent larger-scale trial; and participant acceptability of the intervention, as assessed by participant perceptions of and satisfaction with the intervention. Results: The sample (n=24; mean age 54.1, SD 5.8 years; mean BMI 36.3, SD 5.0 kg/m ² ) was recruited in approximately 4 months, equating to an enrollment rate of 6 participants per month. Retention at 6 months was 87.5% (21/24). Participants completing the intervention attended 85.9% of action planning sessions and wore the Fitbit for >10 hours per day on 87.1% of intervention days. Data collection rates for outcome measures ranged from 96% to 100%. Most participants expressed satisfaction with the intervention, with 86% (18/21) reporting gaining knowledge about PA and 90% (19/21) reporting that they would recommend the study to a friend. Conclusions: The next step in this research is to build on these findings by conducting a larger-scale phase 1B proof-of-concept trial to examine the preliminary effects of the goal-setting techniques for increasing MVPA and promoting adherence to national aerobic PA guidelines.

The phenomenon of ‘tiredness of life’ (ToL) in older adults emerges in societal and political debates on euthanasia and assisted suicide (EAS) as well as in academia. However, the conceptualization of ToL is unclear and seems to be influenced by the socio-political context of studies (i.e., EAS debates). Also, lay perspectives are largely neglected in current conceptualizations, but appear important to assess their usefulness. The current study explored Belgian (n = 512) older adults’ lay ideas on ToL and compared them to those of older adults from a different socio-political context, namely the U.S. (n = 144). Two sets of open-ended questions inquiring about conceptualization and personal experiences with ToL were asked. Directed content analysis was used to examine the fit of lay and current scientific ideas (defining ToL as boredom and aversion towards life, meaninglessness, fatigue). The influence of personal experiences with ToL as well as potential differences between the countries were also explored. Scientific and lay ideas were mostly overlapping. Boredom with life was the most frequent and aversion the least frequent component in both countries. Three additional components were identified in lay ideas. Participants with personal experience with ToL were mentioning most components more frequently. Interestingly, the Belgian codebook did not need to be adapted to fit the U.S. data. This study is a first indication of the usefulness of scientific ToL conceptualizations in different socio-political contexts. Ideas on ways to integrate additional insights into future research on ToL and tailor interventions are discussed.

The negative consequences of childhood maltreatment have been documented across multiple domains, including cognitive functioning in midlife. This study examined the impact of childhood maltreatment on cognitive functioning into late midlife, changes over time, and the extent to which cognitive change over time predicted functional impairment. We use data from a prospective cohort design study in which individuals with documented histories of childhood maltreatment (ages 0-11 years) and demographically matched controls without those histories were interviewed over five study waves: 1989-1995 (N = 1,196; M_age = 29.2 years), 2000-2002 (N = 896; M_age = 39.5 years), 2003-2005 (N = 808; M_age = 41.2 years), 2009-2010 (N = 649; M_age = 47.0 years), and 2022-2023 (N = 447; M_age = 59.4). Tasks assessing verbal intelligence, processing speed, and executive functioning were administered at multiple points, permitting examination of changes over time. The eight-item Informant Interview to Differentiate Aging and Dementia assessed self-perceived change in functioning associated with dementing disorders. Linear mixed effects and structural equation models were used. Childhood maltreatment predicted poorer performance on cognitive tasks in young adulthood and late midlife, except for Stroop, and predicted a steeper decline in performance on the Wide Range Achievement Test-Revised and Trails B. Wide Range Achievement Test-Revised, Matrix Reasoning, and Trails A and B change scores predicted greater perceived functional decline on the eight-item Informant Interview to Differentiate Aging and Dementia, whereas childhood maltreatment did not. The effects of childhood maltreatment on cognitive functioning continue into late midlife, with worse performance on tasks assessing general intelligence, abstract visual reasoning, processing speed, and set-shifting compared with controls. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Problem, Research Strategy, and Findings: Low physical activity (PA) and Type 2 diabetes are associated with cognitive aging and Alzheimer’s disease, but the evidence is inconsistent and particularly limited by ethnicity. The purpose of this study was to examine the relationships of PA and Type 2 diabetes with cognition in Mexican Americans and non-Hispanic Whites. The study was a cross-sectional analysis of the Health and Aging Brain Study-Health Disparities (n = 1,982–2,000 after removing outliers). Predictors included Rapid Assessment of Physical Activity and hemoglobin A1c (HbA1c). Episodic memory was assessed by Weschler Memory Scale–Third Edition Logical Memory and Spanish-English Verbal Learning Test, executive function by Weschler Memory Scale–Third Edition Digit Span and Digit Symbol Substitution Test, verbal fluency by FAS and animal naming, and global cognition by the Mini-Mental State Examination. Results show that aerobic PA and HbA1c were not associated with domain-specific, or global cognition, but strength/flexibility PA was associated with FAS (b = 0.404, 95% CI [0.023, 0.761]). Higher aerobic PA was associated with greater verbal fluency for Mexican Americans (b = 0.294, 95% CI [0.96, 0.497]) only. HbA1c was negatively associated with Mini-Mental State Examination (b = 0.838, 95% CI [0.008, 1.656]). For low HbA1c, the association between aerobic PA and Digit Symbol Substitution Test was significant for non-Hispanic Whites (b = 0.838, 95% CI [0.008, 1.656]) in comparison to Mexican Americans. Takeaway for Practice: The relationships between PA, Type 2 diabetes, and cognition vary by cognitive domains and ethnicity. Increasing aerobic activities may be particularly important for Mexican Americans who have elevated HbA1c to potentially improve fluency or executive function.

Background and ObjectivesDementia-related anxiety (DRA) is the fear or anxiety about a current or future diagnosis of Alzheimer's disease or another type of dementia. The purpose of the present study was to examine management of DRA.Methods and DesignIn semi-structured qualitative interviews, 50 community-dwelling adults (58-89 years old, M = 70.80, SD = 6.02) without dementia diagnoses reflected on their thoughts and feelings about dementia. A reflexive inductive thematic approach was used to examine ways people managed DRA.ResultsWe identified five themes related to managing DRA: monitoring cognitive status (e.g., self-monitoring or objective assessment); active coping strategies (e.g., using external reminders, normalizing age-related change); interpersonal relationships and support (e.g., anticipating benefit of support from others); planning and preparing for potential outcomes (e.g., securing power of attorney, saying goodbyes); and personal responsibility to manage risk or accept diagnosis (e.g., lifestyle factors to reduce dementia risk, thereby reducing risk for burdening others).ConclusionsFindings suggest internal and external means for coping with DRA that are likely to vary in degrees of usefulness. We consider findings within the context of relevant, established theories, attending to potential clinical interventions for individuals experiencing DRA.

Background and Objectives: Public health messaging increasingly emphasizes the importance of “lifestyle interventions” to reduce dementia risk. Our study aimed to understand how people interpret and respond to information about dementia risk. In a second sub-aim, we examined how these interpretations may contribute to dementia-related lifestyle stigma. Research Design and Methods: We engaged in a secondary analysis of 50 semi-structured interviews using a framework approach to understand, from the perspective of community-dwelling middle-aged and older adults, how they may interpret, make sense of, and respond to information about dementia risk and risk reduction. During the interpretive and narrative phase, the authors began to elucidate participant responses analytically and identified that these responses could be interpreted within the health locus of control literature. Results: Of the 23 participants who discussed dementia risk, 13 felt some sense of personal responsibility and control over their dementia risk. Of those 13, four participants believed they had personal responsibility and control and actively engaged in lifestyle interventions. The remaining nine participants also engaged in lifestyle interventions, aiming to find comfort in knowing they had done what they could to reduce their risk and working to alleviate self-attribution of blame if diagnosed with dementia. Discussion and Implications: The tendency to internalize responsibility may inadvertently contribute to the stigmatization of dementia as a ‘lifestyle disease’ creating dementia-related lifestyle stigma. Recognizing the multifaceted nature of dementia risk, including environmental and external factors beyond individual control, is essential to combatting the ‘lifestyle stigma’ increasingly associated with the condition.

Negative consequences of childhood maltreatment have been well-documented, including poorer executive functioning and nonverbal reasoning in midlife. However, not all adults with a history of childhood maltreatment manifest these outcomes, suggesting the presence of risk and protective factors. Based on growing empirical support for the importance of social variables in understanding neuropsychological development and functioning, we examined whether social support and social isolation mediate or moderate the effects of childhood maltreatment on cognitive functioning in midlife. In the context of a prospective cohort design study, individuals with documented histories of childhood maltreatment (ages 0-11 years) and demographically matched controls were followed up and interviewed in adulthood. Social support and isolation were assessed in young adulthood (M_age = 29), and cognitive functioning was assessed in midlife (M_age = 41). Structural equation modeling was used for mediation and linear regressions for moderation. Childhood maltreatment predicted higher levels of social isolation and lower levels of social support and cognitive functioning. Only social isolation mediated the relationship between childhood maltreatment and midlife cognitive functioning, whereas childhood maltreatment interacted with social support to predict Matrix Reasoning in midlife. Social support was protective for the control group but not for those maltreated. Social isolation and social support play different roles in understanding how childhood maltreatment impacts midlife cognitive functioning. Greater social isolation predicts greater deficits in cognitive functioning overall, whereas the protective effects of social support are limited to those without a documented history of childhood maltreatment. Clinical implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).