title: Longitudinal Cognitive Trajectories of Women Veterans from the Women's Health Initiative Memory Study.
abstract: OBJECTIVE
  A comparison of longitudinal global cognitive functioning in women Veteran and non-Veteran participants in the Women's Health Initiative (WHI).
  
  
  METHODS
  We studied 7,330 women aged 65-79 at baseline who participated in the WHI Hormone Therapy Trial and its ancillary Memory Study (WHIMS). Global cognitive functioning (Modified Mini-Mental State Examination [3MSE]) in Veterans (n = 279) and non-Veterans (n = 7,051) was compared at baseline and annually for 8 years using generalized linear modeling methods.
  
  
  RESULTS
  Compared with non-Veterans, Veteran women were older, more likely to be Caucasian, unmarried, and had higher rates of educational and occupational attainment. Results of unadjusted baseline analyses suggest 3MSE scores were similar between groups. Longitudinal analyses, adjusted for age, education, ethnicity, and WHI trial assignment revealed differences in the rate of cognitive decline between groups over time, such that scores decreased more in Veterans relative to non-Veterans. This relative difference was more pronounced among Veterans who were older, had higher educational/occupational attainment and greater baseline prevalence of cardiovascular risk factors (e.g., smoking) and cardiovascular disease (e.g., angina, stroke).
  
  
  CONCLUSIONS
  Veteran status was associated with higher prevalence of protective factors that may have helped initially preserve cognitive functioning. However, findings ultimately revealed more pronounced cognitive decline among Veteran relative to non-Veteran participants, likely suggesting the presence of risks that may impact neuropathology and the effects of which were initially masked by Veterans' greater cognitive reserve.
authors.affiliation: VA Palo Alto Health Care System, Sierra Pacific MIRECC and Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, California. padula@stanford.edu.
authors.forename: Claudia B
authors.initials: CB
authors.lastname: Padula
authors.affiliation: VA Palo Alto Health Care System, Sierra Pacific MIRECC and Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, California. VA Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Weitlauf
authors.affiliation: VA Palo Alto Health Care System, Sierra Pacific MIRECC and Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, California.
authors.forename: Allyson C
authors.initials: AC
authors.lastname: Rosen
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Gayle
authors.initials: G
authors.lastname: Reiber
authors.affiliation: School of Nursing, University of Washington School of Nursing, Seattle.
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Cochrane
authors.affiliation: Division of Population Sciences, College of Medicine, The Ohio State University, Columbus.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Naughton
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester. Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: Durham VA Medical Center, Mid-Atlantic MIRECC, Durham, North Carolina.
authors.forename: Michelle
authors.initials: M
authors.lastname: Rissling
authors.affiliation: UCSF Department of Psychiatry, Neurology and Epidemiology and Biostatistics, San Francisco VA Medical Center, Sierra Pacific MIRECC, California.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Hunt
authors.affiliation: Department of Medicine (Stanford Center for Prevention Research), Stanford University School of Medicine, California. Department of Obstetrics & Gynecology, Stanford University School of Medicine, California.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: VA Palo Alto Health Care System, GRECC, Stanford University School of Medicine, Department of Medicine, Center for Primary Care & Outcomes Research, Palo Alto, California.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.affiliation: Wake Forest School of Medicine, Department of Biostatistical Sciences, One Medical Center Blvd, Winston-Salem, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008568:Memory / Q000502:physiology*; D009483:Neuropsychological Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D016387:Women's Health
keywords: Cognition; Cognitive decline; Risk factors; Veterans; Women