Professor M Kivimaki
University College London
Adult Determinants of Late Life Depression, Cognitive Decline and Physical Functioning - The Whitehall II Ageing Study
Neurodegenerative disease in general
We propose to examine mid-life factors as determinants of key age-related conditions: late-life depression, cognitive decline and physical functioning in the Whitehall II prospective cohort study (WII) of 10,308 London-based civil servants, established in 1985. Using new data collected at a 7th clinical screening to define endpoints and 30 years of prospective follow-up, we hypothesise that mid-life trajectories of inflammatory, vascular, and metabolic factors will make major contributions to later life depression, cognitive impairment, and functional health. We will examine the role of socioeconomic status, social engagement and cognitive reserve as contextual influences (‘the causes of the causes’), and quantify the importance of lifestyle factors through adulthood. Confirming generalisability in other studies, we will translate observed effects into impact on the prevalence of functional limitations and disability-free life expectancy using projected risk factor distributions in the general population. Where appropriate, we will develop multi-factorial predictive algorithms, like those previously developed for cardiovascular diseases, to facilitate early identification of adverse ageing outcomes. The proposed clinic will include the following measures: psychiatric disorders via computerised interview (CIS-R) and symptoms scales; cognitive function via 6 tests (MMSE, memory, reasoning, fluency, vocabulary, trail making test); physical function via 5 tests (walking speed, chair rises, grip strength, finger tapping, lung function); anthropometry; blood-based measures; hair cortisol; and socioeconomic, social, psychological and behavioural factors, including 9-day accelerometer data and the facial expression recognition. To provide complementary data, participants are linked to national health registers for surveillance of cause-specific morbidity and mortality. Findings of the programme will inform health policies at national and international levels.