{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T23:22:44Z","timestamp":1794007364593,"version":"4.8.0"},"reference-count":55,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,18]],"date-time":"2020-09-18T00:00:00Z","timestamp":1600387200000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Department of Veterans Affairs, Veterans Health Administration"},{"name":"National Institute on Aging, National Institute of Health","award":["U01 P50 AG005138"],"award-info":[{"award-number":["U01 P50 AG005138"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,8,5]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate whether allostatic load (AL), a measure of cumulative biological risk, fully or partially mediates observed socioeconomic status (SES) differences in cognitive function in the elderly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community-dwelling US elderly who participated in the National Health and Nutrition Examination Survey (NHANES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The NHANES uses a complex, multistage, probability sampling design to select a nationally representative sample. Of the 4976 elderly (60 years or older) who were selected, 3234 agreed to participate in the household and medical exam interviews (65% response rate).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Performance on the Digit Symbol Substitution Test (DSST)\u2014a measure of cognitive function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Relative to participants with the lowest level of education or family income, participants who were college graduates (\u03b2=24.4, 95%\u2009CI 22 to 26.8, p&lt;0.0001) or in the highest income quartile (\u03b2=17.3, 95%\u2009CI 15.2 to 19.4, p&lt;0.0001) had the highest DSST scores and the least AL burden (\u03b2=\u22120.72, 95%\u2009CI \u22120.98 to \u22120.47 and \u03b2=\u22120.82, 95%\u2009CI \u22121 to \u22120.57; p&lt;0.0001, respectively). Although, AL was significantly negatively associated with cognitive performance (\u03b2 = \u22121, 95%\u2009CI \u22121.4 to \u22120.5, p&lt;0.0001), it mediated at most 4.5% of the SES effect on DSST performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings suggest that AL, as measured by a summary index of parameters for cardiovascular function, metabolism and chronic inflammation, is not a significant mediator of SES-related differences in cognitive function in the elderly. Further efforts are required to elucidate the exact physiological pathways and mechanisms through which SES impacts cognitive function in late life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035847","type":"journal-article","created":{"date-parts":[[2020,9,18]],"date-time":"2020-09-18T18:30:14Z","timestamp":1600453814000},"page":"e035847","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Role of cumulative biological risk in mediating socioeconomic disparities in cognitive function in the elderly: a mediation analysis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8872-6652","authenticated-orcid":false,"given":"Jimmy","family":"Akrivos","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Alzheimer\u2019s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn Wei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahram","family":"Haroutunian","sequence":"additional","affiliation":[{"name":"Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,18]]},"reference":[{"key":"2026062608031593000_10.9.e035847.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504327"},{"key":"2026062608031593000_10.9.e035847.2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31828726f5"},{"key":"2026062608031593000_10.9.e035847.3","unstructured":"Ortman JM , Velkoff VA , Hogan H . 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