Department of Geriatrics

: Feeling Older and the Development of Cognitive Impairment and Dementia.; Subjective age is a biopsychosocial marker of aging associated with a range of outcomes in old age. In the domain of cognition, feeling older than one's chronological age is related to lower cognitive performance and steeper cognitive decline among older adults. The present study examines whether an older subjective age is associated with the risk of incident cognitive impairment and dementia. Participants were 5,748 individuals aged 65 years and older drawn from the Health and Retirement Study. Measures of subjective age, cognition, and covariates were obtained at baseline, and follow-up cognition was assessed over a 2- to 4-year period. Only participants without cognitive impairment were included at baseline. At follow-up, participants were classified into one of the three categories: normal functioning, cognitive impairment without dementia (CIND), and dementia. An older subjective age at baseline was associated with higher likelihood of CIND (odds ratio [OR] = 1.18; 1.09-1.28) and dementia (OR = 1.29; 1.02-1.63) at follow-up, controlling for chronological age, other demographic factors, and baseline cognition. Physical inactivity and depressive symptoms partly accounted for these associations. An older subjective age is a marker of individuals' risk of subsequent cognitive impairment and dementia., Keywords: Cognitive impairment, Dementia, Subjective age, Grant Number: R03 AG051960, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927095.

: Five-Factor Model Personality Profiles of Drug Users; BACKGROUND: Personality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals' traits. Furthermore, there is increasing interest in developing treatment approaches that match an individual's personality profile. To advance our knowledge of the role of individual differences in drug use, the present study compares the personality profile of tobacco, marijuana, cocaine, and heroin users and non-users using the wide spectrum Five-Factor Model (FFM) of personality in a diverse community sample. METHOD: Participants (N = 1,102; mean age = 57) were part of the Epidemiologic Catchment Area (ECA) program in Baltimore, MD, USA. The sample was drawn from a community with a wide range of socio-economic conditions. Personality traits were assessed with the Revised NEO Personality Inventory (NEO-PI-R), and psychoactive substance use was assessed with systematic interview. RESULTS: Compared to never smokers, current cigarette smokers score lower on Conscientiousness and higher on Neuroticism. Similar, but more extreme, is the profile of cocaine/heroin users, which score very high on Neuroticism, especially Vulnerability, and very low on Conscientiousness, particularly Competence, Achievement-Striving, and Deliberation. By contrast, marijuana users score high on Openness to Experience, average on Neuroticism, but low on Agreeableness and Conscientiousness. CONCLUSION: In addition to confirming high levels of negative affect and impulsive traits, this study highlights the links between drug use and low Conscientiousness. These links provide insight into the etiology of drug use and have implications for public health interventions., Keywords: substance abuse, cocaine, heroin dependence, marijuana abuse, personality, smoking, Uncontrolled subjects: Baltimore, Cocaine-Related Disorders, Cross-Sectional Studies, Heroin Dependence, Humans, Marijuana Abuse, Middle Aged, Models, Psychological, Personality, Prevalence, Sample Size, Smoking, Substance-Related Disorders, Note: Originally published in BMC Psychiatry., Citation: Terracciano A, Loeckenhoff CE, RM Crum, OJ Bienvenu & Costa PT Jr. (2008) Five-Factor Model personality profiles of drug users. BMC Psychiatry, 8:22.

: Five-Factor Model Personality Traits and the Retirement Transition; The authors examined associations between 5-factor personality traits and retirement in a diverse community sample. Longitudinal analyses (n = 367) compared personality trajectories of participants who remained employed and participants who retired. Personality at baseline did not predict future retirement, but compared to participants who remained employed, retirees increased in Agreeableness and decreased in Activity, a facet of Extraversion. In cross-sectional analyses among retirees (n = 144), those low in Neuroticism and high in Extraversion reported higher retirement satisfaction, and those high in Extraversion reported higher postretirement activity levels. Findings suggest that the trait perspective contributes to the understanding of the retirement process., Keywords: retirement, personality traits, five-factor model, longitudinal, aging, Uncontrolled subjects: Aged, Aging, Anxiety, Baltimore, Cross-Sectional Studies, Extraversion (Psychology), Female, Health Surveys, Humans, Interpersonal Relations, Longitudinal Studies, Male, Middle Aged, Motor Activity, Personal Satisfaction, Personality Inventory, Retirement, Note: Published in final edited form as: Psychol Aging. 2009 September; 24(3): 722–728. doi: 10.1037/a0015121, Citation: Loeckenhoff CE, Terracciano A, & Costa PT Jr. (2009). Five-Factor Model personality traits and the retirement transition: Longitudinal and cross-sectional associations. Psychology and Aging, 24, 722-728.

: Five-Factor Model of Personality and Physical Inactivity; A sedentary lifestyle is harmful for health; personality traits may contribute to physical (in)activity. With participant-level data from 16 samples (>125,000), we examined the personality correlates of physical inactivity, frequency of physical activity, and sedentary behavior (in a subset of samples). Lower Neuroticism and higher Conscientiousness were associated with more physical activity and less inactivity and sedentary behavior. Extraversion and Openness were also associated with more physical activity and less inactivity, but these traits were mostly unrelated to specific sedentary behaviors (e.g., TV watching). The results generally did not vary by age or sex. The findings support the notion that the interest, motivational, emotional, and interpersonal processes assessed by five-factor model traits partly shape the individual's engagement in physical activity., Keywords: Conscientiousness, Five factor model, Personality, Physical activity, Sedentary behavior, Grant Number: R15 HD083947, R01 AG041868, P01 HD031921, UL1 TR000427, U01 AG009740, U01 AG032947, R37 AG027343, P01 AG021079, M01 RR000865, R01 AG033285, R01 AG053297, R01 AG009775, M01 RR023942, R01 AG017644, P01 AG020166, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650243.

: Five-Factor Personality Traits and Age Trajectories of Self-Rated Health; We examined the influence of personality traits on mean levels and age trends in 4 single-item measures of self-rated health: general rating, comparison to age peers, comparison to past health, and expectations for future health. Community-dwelling participants (N = 1,683) completed 7,474 self-rated health assessments over a period of up to 19 years. In hierarchical linear modeling analyses, age-associated declines differed across the 4 health items. Across age groups, high Neuroticism and low Conscientiousness, low Extraversion, and low Openness were associated with worse health ratings, with notable differences across the 4 health items. Furthermore, high Neuroticism predicted steeper declines in health ratings involving temporal comparisons. We consider theoretical implications regarding the mechanisms behind associations among personality traits and self-rated health., Keywords: Personality traits, aging, self-rated health, subjective health, hierarchical linear modeling, Uncontrolled subjects: Adult, Aged, Attitude to Health, Consciousness, Extraversion (Psychology), Female, Health Behavior, Health Status, Humans, Introversion (Psychology), Linear Models, Male, Mental Health, Middle Aged, Personality, Personality Inventory, Questionnaires, Self Efficacy, Note: Published in final edited form as: J Pers. 2012 April; 80(2): 375–401., Citation: Loeckenhoff CE, Terracciano A, Ferrucci L, & Costa PT Jr. (2012). Five-Factor personality traits and age trajectories of self-rated health: The role of question framing. Journal of Personality, 80, 375-401.

: GWAS of 126,559 Individuals Identifies Genetic Variants Associated with Educational Attainment; A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics., Keywords: cognition, educational status, endophenotypes, genetic loci, multifactorial inheritance, polymorphism, single nucleotide, Uncontrolled subjects: Cognition, Educational Status, Endophenotypes, Female, Genetic Loci, Genome-Wide Association Study, Humans, Male, Multifactorial Inheritance, Polymorphism, Single Nucleotide, Note: Published in final edited form as: Science. 2013 June 21; 340(6139): 1467–1471. doi:10.1126/science.1235488, Citation: Rietveld CA, Medland SE, Derringer J, Yang J, Esko T, Martin NW, Westra HJ, Shakhbazov K, Abdellaoui A, Agrawal A, Albrecht E, Alizadeh BZ, Amin N, Barnard J, Baumeister SE, Benke KS, Bielak LF, Boatman JA, Boyle PA, Davies G, de Leeuw C, Eklund N, Evans DS, Ferhmann R, Fischer K, Gieger C, Gjessing HK, Hägg S, Harris JR, Hayward C, Holzapfel C, Ibrahim-Verbaas CA, Ingelsson E, Jacobsson B, Joshi PK, Jugessur A, Kaakinen M, Kanoni S, Karjalainen J, Kolcic I, Kristiansson K, Kutalik Z, Lahti J, Lee SH, Lin P, Lind PA, Liu Y, Lohman K, Loitfelder M, McMahon G, Vidal PM, Meirelles O, Milani L, Myhre R, Nuotio ML, Oldmeadow CJ, Petrovic KE, Peyrot WJ, Polasek O, Quaye L, Reinmaa E, Rice JP, Rizzi TS, Schmidt H, Schmidt R, Smith AV, Smith JA, Tanaka T, Terracciano A, van der Loos MJ, Vitart V, Völzke H, Wellmann J, Yu L, Zhao W, Allik J, Attia JR, Bandinelli S, Bastardot F, Beauchamp J, Bennett DA, Berger K, Bierut LJ, Boomsma DI, Bültmann U, Campbell H, Chabris CF, Cherkas L, Chung MK, Cucca F, de Andrade M, De Jager PL, De Neve JE, Deary IJ, Dedoussis GV, Deloukas P, Dimitriou M, Eiriksdottir G, Elderson MF, Eriksson JG, Evans DM, Faul JD, Ferrucci L, Garcia ME, Grönberg H, Gudnason V, Hall P, Harris JM, Harris TB, Hastie ND, Heath AC, Hernandez DG, Hoffmann W, Hofman A, Holle R, Holliday EG, Hottenga JJ, Iacono WG, Illig T, Järvelin MR, Kähönen M, Kaprio J, Kirkpatrick RM, Kowgier M, Latvala A, Launer LJ, Lawlor DA, Lehtimäki T, Li J, Lichtenstein P, Lichtner P, Liewald DC, Madden PA, Magnusson PK, Mäkinen TE, Masala M, McGue M, Metspalu A, Mielck A, Miller MB, Montgomery GW, Mukherjee S, Nyholt DR, Oostra BA, Palmer LJ, Palotie A, Penninx B, Perola M, Peyser PA, Preisig M, Räikkönen K, Raitakari OT, Realo A, Ring SM, Ripatti S, Rivadeneira F, Rudan I, Rustichini A, Salomaa V, Sarin AP, Schlessinger D, Scott RJ, Snieder H, St Pourcain B, Starr JM, Sul JH, Surakka I, Svento R, Teumer A; The LifeLines Cohort Study, Tiemeier H, van Rooij FJ, Van Wagoner DR, Vartiainen E, Viikari J, Vollenweider P, Vonk JM, Waeber G, Weir DR, Wichmann HE, Widen E, Willemsen G, Wilson JF, Wright AF, Conley D, Davey-Smith G, Franke L, Groenen PJ, Hofman A, Johannesson M, Kardia SL, Krueger RF, Laibson D, Martin NG, Meyer MN, Posthuma D, Thurik AR, Timpson NJ, Uitterlinden AG, van Duijn CM, Visscher PM, Benjamin DJ, Cesarini D, & Koellinger PD (2013). GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. Science, 340, 1467-1471.

: Gender specific profiles of white coat and masked hypertension impacts on arterial structure and function in the SardiNIA study.; Keywords: 24hour blood pressure monitoring, Arterial aging, Arterial stiffness, Carotid thickness, Masked hypertension, Pulse wave velocity, White coat hypertension, Grant Number: Z01 AG000237-01, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206901.

: Genetic Association Between Personality and Major Depression or Bipolar Disorder. A Polygenic Score Analysis Using Genome-wide Association Data; The relationship between major depressive disorder (MDD) and bipolar disorder (BD) remains controversial. Previous research has reported differences and similarities in risk factors for MDD and BD, such as predisposing personality traits. For example, high neuroticism is related to both disorders, whereas openness to experience is specific for BD. This study examined the genetic association between personality and MDD and BD by applying polygenic scores for neuroticism, extraversion, openness to experience, agreeableness and conscientiousness to both disorders. Polygenic scores reflect the weighted sum of multiple single-nucleotide polymorphism alleles associated with the trait for an individual and were based on a meta-analysis of genome-wide association studies for personality traits including 13,835 subjects. Polygenic scores were tested for MDD in the combined Genetic Association Information Network (GAIN-MDD) and MDD2000+ samples (N=8921) and for BD in the combined Systematic Treatment Enhancement Program for Bipolar Disorder and Wellcome Trust Case-Control Consortium samples (N=6329) using logistic regression analyses. At the phenotypic level, personality dimensions were associated with MDD and BD. Polygenic neuroticism scores were significantly positively associated with MDD, whereas polygenic extraversion scores were significantly positively associated with BD. The explained variance of MDD and BD, ∼0.1%, was highly comparable to the variance explained by the polygenic personality scores in the corresponding personality traits themselves (between 0.1 and 0.4%). This indicates that the proportions of variance explained in mood disorders are at the upper limit of what could have been expected. This study suggests shared genetic risk factors for neuroticism and MDD on the one hand and for extraversion and BD on the other., Keywords: Bipolar Disorder/genetics, depressive disorder, genome-wide association study, personality/genetics, multifactorial inheritance/genetics, Uncontrolled subjects: Adult, Aged, Bipolar Disorder, Depressive Disorder, Major, Female, Genome-Wide Association Study, Humans, Male, Meta-Analysis as Topic, Middle Aged, Multifactorial Inheritance, Personality, Personality Inventory, Registries, Note: Published online 2011 October 18 in Translational Psychiatry. doi: 10.1038/tp.2011.45., Citation: Middeldorp CM, De Moor MHM, McGrath LM, Gordon SD, Blackwood DH, Costa PT, Terracciano A, Krueger RF, De Geus EJC, Nyholt DR, Tanaka T, Esko T, Madden PAF, Derringer J, Amin N, Willemsen G, Hottenga J-J, Distel MA, Uda M, Sanna S, Spinhoven P, Hartman CA, Ripke S, Sullivan PF, Realo A, Allik J, Heath AC, Pergadia ML, Agrawal A, Lin P, Grucza RA, Widen E, Cousminer DL, Eriksson JG, Palotie A, Barnett JH, Lee PH, Luciano M, Tenesa A, Davies G, Lopez LM, Hansell NK, Medland SE, Ferrucci L, Schlessinger D, Montgomery GW, Wright MJ, Aulchenko YS, Janssens ACJW, Oostra BA, Metspalu A, Abecasis GR, Deary IJ, Räikkönen K, Bierut LJ, Martin NG, Wray NR, Van Duijn CM, Smoller JW, Penninx BWJH, & Boomsma DI (2011). The genetic association between personality and major depression or bipolar disorder. A polygenic score analysis using genome-wide association data. Translational Psychiatry, 1, e50. doi: 10.1038/tp.2011.45

: Genome-wide association study identifies 74 loci associated with educational attainment.; Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases., Grant Number: R01 DA036216, RF1 AG015819, U01 AG009740, MC_UU_12013/3, MC_QA137853, R01 AG017917, MR/J012165/1, MR/K026992/1, P2C HD047879, P30 AG010161, MC_UU_12013/1, MC_UU_12013/4, CZD/16/6/4, MC_PC_U127561128, T32-AG000186-23, P01-AG005842, R01-AG042568, P30-AG012810, P01 AG005842, R37 DA005147, P30 AG012810, R01 AG042568, T32 AG000186, BB/F022441/1, P01-AG005842-20S2, 647648, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883595.

: Health Literacy as a Tool to Improve the Public Understanding of Alzheimer's Disease; The ultimate goal of health literacy is to improve care by enhancing the patient's quality of life, maximizing clinical outcomes, and reducing inequities in health. Successful restructuring of the healthcare system to make it more effective, efficient, and equitable demands that health literacy be integrated as a key source of theoretical and empirical data regarding patients' needs and wishes. This applies across the life course, but it is especially true for the increasing numbers of older adults who must deal with the medical care system the most, yet often comprehend medical information the least. Nearly nine out of ten people in the United States do not have the level of proficiency in health literacy skills necessary to successfully navigate the healthcare system. According to the National Assessment of Adult Literacy (NAAL), populations overrepresented at the lowest levels of health literacy (below basic level) in the United States include people over age 65, those who did not graduate from high school, persons who did not speak English before starting school, people who have poor health status, those who are of racial and ethnic minority groups, and individuals without medical insurance. An increasing number of efforts are ongoing across the United States and internationally to address health literacy. Significant national initiatives include Healthy People 2010, the Joint Commission's report "Improving Health Literacy to Protect Patient Safety," and the U.S. Department of Heath and Human Services Office of the Surgeon General's "Workshop on Improving Health Literacy." Other organizations attempting to address health literacy include the American Medical Association and the Partnership for Clear Health Communication. Many organizations are launching successful health literacy–based interventions such as the Canyon Ranch Institute's Life Enhancement Program, an integrated approach to prevention and wellness. Additionally, there are a growing number of curricula addressing health literacy being developed by a wide range of organizations and individuals. Equally significant efforts are ongoing in a number of countries around the world, particularly Canada, Australia, and Switzerland. The purposes of this article are to familiarize readers with the concept of health literacy; demonstrate how health literacy can serve as a tool to improve the public's understanding of Alzheimer's disease (AD), the seventh leading cause of death; and suggest generally applicable strategies for clinicians., Keywords: health literacy, Alzheimer's Disease, elderly, older adults, patients, dementia, Note: Originally published online in Annals of Long-Term Care, Citation: Kobylarz FA, Pomidor AK, Pleasant A. Health literacy as a tool to improve the public understanding of Alzheimer's disease. Annals of Long Term Care 2010;18:34-40.

: Heritability of Cardiovascular and Personality Traits in 6,148 Sardinians; In family studies, phenotypic similarities between relatives yield information on the overall contribution of genes to trait variation. Large samples are important for these family studies, especially when comparing heritability between subgroups such as young and old, or males and females. We recruited a cohort of 6,148 participants, aged 14-102 y, from four clustered towns in Sardinia. The cohort includes 34,469 relative pairs. To extract genetic information, we implemented software for variance components heritability analysis, designed to handle large pedigrees, analyze multiple traits simultaneously, and model heterogeneity. Here, we report heritability analyses for 98 quantitative traits, focusing on facets of personality and cardiovascular function. We also summarize results of bivariate analyses for all pairs of traits and of heterogeneity analyses for each trait. We found a significant genetic component for every trait. On average, genetic effects explained 40% of the variance for 38 blood tests, 51% for five anthropometric measures, 25% for 20 measures of cardiovascular function, and 19% for 35 personality traits. Four traits showed significant evidence for an X-linked component. Bivariate analyses suggested overlapping genetic determinants for many traits, including multiple personality facets and several traits related to the metabolic syndrome; but we found no evidence for shared genetic determinants that might underlie the reported association of some personality traits and cardiovascular risk factors. Models allowing for heterogeneity suggested that, in this cohort, the genetic variance was typically larger in females and in younger individuals, but interesting exceptions were observed. For example, narrow heritability of blood pressure was approximately 26% in individuals more than 42 y old, but only approximately 8% in younger individuals. Despite the heterogeneity in effect sizes, the same loci appear to contribute to variance in young and old, and in males and females. In summary, we find significant evidence for heritability of many medically important traits, including cardiovascular function and personality. Evidence for heterogeneity by age and sex suggests that models allowing for these differences will be important in mapping quantitative traits., Keywords: aging, cardiovascular diseases, cardiovascular physiological phenomena, chromosomes, genes, mitochondrial, multifactorial inheritance, personality, quantitative trait, sex characteristics, siblings, Uncontrolled subjects: Adolescent, Adult, Aged, Aged, 80 and over, Aging, Analysis of Variance, Cardiovascular Diseases, Cardiovascular Physiological Phenomena, Chromosomes, Human, X, Cohort Studies, Female, Genes, Mitochondrial, Humans, Italy, Male, Middle Aged, Models, Genetic, Multifactorial Inheritance, Personality, Quantitative Trait, Heritable, Sex Characteristics, Siblings, Note: Originally published in PLoS Genetics., Citation: Pilia G, Chen W, Scuteri A, Orrú M, Albai G, Dei M, Lai S, Usala G, Lai M, Loi P, Mameli C, Vacca L, Deiana M, Olla N, Masala M, Cao A, Najjar SS, Terracciano A, Nedorezov T, Sharov A, Zonderman AB, Abecasis GR, Costa PT Jr, Lakatta E, & Schlessinger D (2006). Heritability of cardiovascular and personality traits in 6,148 Sardinians. PloS Genetics, 2: e132; 1207-1223.

: Hierarchical Linear Modeling Analyses of the NEO-PI-R Scales in the Baltimore Longitudinal Study of Aging; The authors examined age trends in the 5 factors and 30 facets assessed by the Revised NEO Personality Inventory in Baltimore Longitudinal Study of Aging data (N=1,944; 5,027 assessments) collected between 1989 and 2004. Consistent with cross-sectional results, hierarchical linear modeling analyses showed gradual personality changes in adulthood: a decline in Neuroticism up to age 80, stability and then decline in Extraversion, decline in Openness, increase in Agreeableness, and increase in Conscientiousness up to age 70. Some facets showed different curves from the factor they define. Birth cohort effects were modest, and there were no consistent Gender x Age interactions. Significant nonnormative changes were found for all 5 factors; they were not explained by attrition but might be due to genetic factors, disease, or life experience., Keywords: Five-Factor Model, personality change, aging, longitudinal study, HLM, gender, Uncontrolled subjects: Adult, Aged, Aged, 80 and over, Aging, Baltimore, Cohort Studies, Female, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Personality Development, Personality Inventory, Psychometrics, Reference Values, Sex Factors, Note: Published in final edited form as: Psychol Aging. 2005 September; 20(3): 493–506. doi: 10.1037/0882-7974.20.3.493, Citation: Terracciano A, McCrae RR, Brant LJ, & Costa PT Jr. (2005). Hierarchical linear modeling analyses of NEO-PI-R scales in the Baltimore Longitudinal Study of Aging. Psychology and Aging, 20, 493-506.

: Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida.; Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups., Keywords: Access to care, Community health centers, Disease management, Health outcomes, Impact evaluation, Patient-centeredness, Primary care, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932745.

: Increased Genetic Vulnerability to Smoking at CHRNA5 in Early-Onset Smokers; CONTEXT: Recent studies have shown an association between cigarettes per day (CPD) and a nonsynonymous single-nucleotide polymorphism in CHRNA5, rs16969968. OBJECTIVE: To determine whether the association between rs16969968 and smoking is modified by age at onset of regular smoking. DATA SOURCES: Primary data. STUDY SELECTION: Available genetic studies containing measures of CPD and the genotype of rs16969968 or its proxy. DATA EXTRACTION: Uniform statistical analysis scripts were run locally. Starting with 94,050 ever-smokers from 43 studies, we extracted the heavy smokers (CPD >20) and light smokers (CPD ≤10) with age-at-onset information, reducing the sample size to 33,348. Each study was stratified into early-onset smokers (age at onset ≤16 years) and late-onset smokers (age at onset >16 years), and a logistic regression of heavy vs light smoking with the rs16969968 genotype was computed for each stratum. Meta-analysis was performed within each age-at-onset stratum. DATA SYNTHESIS: Individuals with 1 risk allele at rs16969968 who were early-onset smokers were significantly more likely to be heavy smokers in adulthood (odds ratio [OR] = 1.45; 95% CI, 1.36-1.55; n = 13,843) than were carriers of the risk allele who were late-onset smokers (OR = 1.27; 95% CI, 1.21-1.33, n = 19,505) (P = .01). CONCLUSION: These results highlight an increased genetic vulnerability to smoking in early-onset smokers., Keywords: gene-environment interaction, genetic predisposition to disease, nerve tissue proteins, nicotine, polymorphism, single nucleotide, receptors, Nicotinic, Severity of Illness Index, smoking, tobacco use, Uncontrolled subjects: Adolescent, Adolescent Development, Adult, Age of Onset, Europe, Female, Gene-Environment Interaction, Genetic Association Studies, Genetic Predisposition to Disease, Humans, Male, Nerve Tissue Proteins, Nicotine, Polymorphism, Single Nucleotide, Receptors, Nicotinic, Severity of Illness Index, Smoking, Tobacco Use Disorder, Note: Arch Gen Psychiatry. Author manuscript; available in PMC 2013 August 1. Published in final edited form as: Arch Gen Psychiatry. 2012 August; 69(8): 854–860. doi: 10.1001/archgenpsychiatry.2012.124, Citation: Hartz SM, Short SE, Saccone NL, Culverhouse R, Chen L, Schwantes-An TH, Coon H, Han Y, Stephens SH, Sun J, Chen X, Ducci F, Dueker N, Franceschini N, Frank J, Geller F, Gubjartsson D, Hansel NN, Jiang C, Keskitalo-Vuokko K, Liu Z, Lyytikäinen LP, Michel M, Rawal R, Rosenberger A, Scheet P, Shaffer JR, Teumer A, Thompson JR, Vink JM, Vogelzangs N, Wenzlaff AS, Wheeler W, Xiao X, Yang BZ, Aggen SH, Balmforth AJ, Baumeister SE, Beaty T, Bennett S, Bergen AW, Boyd HA, Broms U, Campbell H, Chatterjee N, Chen J, Cheng YC, Cichon S, Couper D, Cucca F, Dick DM, Foroud T, Furberg H, Giegling I, Gu F, Hall AS, Hällfors J, Han S, Hartmann AM, Hayward C, Heikkilä K, Hewitt JK, Hottenga JJ, Jensen MK, Jousilahti P, Kaakinen M, Kittner SJ, Konte B, Korhonen T, Landi MT, Laatikainen T, Leppert M, Levy SM, Mathias RA, McNeil DW, Medland SE, Montgomery GW, Muley T, Murray T, Nauck M, North K, Pergadia M, Polasek O, Ramos EM, Ripatti S, Risch A, Ruczinski I, Rudan I, Salomaa V, Schlessinger D, Styrkársdóttir U, Terracciano A, Uda M, Willemsen G, Wu X, Abecasis G, Barnes K, Bickeböller H, Boerwinkle E, Boomsma DI, Caporaso N, Duan J, Edenberg HJ, Francks C, Gejman PV, Gelernter J, Grabe HJ, Hops H, Jarvelin MR, Viikari J, Kähönen M, Kendler KS, Lehtimäki T, Levinson DF, Marazita ML, Marchini J, Melbye M, Mitchell BD, Murray JC, Nöthen MM, Penninx BW, Raitakari O, Rietschel M, Rujescu D, Samani NJ, Sanders AR, Schwartz AG, Shete S, Shi J, Spitz M, Stefansson K, Swan GE, Thorgeirsson T, Völzke H, Wei Q, Wichmann HE, Amos CI, Breslau N, Cannon DS, Ehringer M, Grucza R, Hatsukami D, Heath A, Johnson EO, Kaprio J, Madden P, Martin NG, Stevens VL, Stitzel JA, Weiss RB, Kraft P, & Bierut LJ. (2012) Increased Genetic Vulnerability to Smoking at CHRNA5 in Early-Onset Smokers. Arch Gen Psychiatry, 69, 854-60.

: Individual Difference Variables, Affective Differentiation, and the Structures of Affect; Methodological arguments are usually invoked to explain variations in the structure of affect. Using self-rated affect from Italian samples (N=600), we show that individual difference variables related to affective differentiation can moderate the observed structure. Indices of circumplexity and congruence coefficients to the hypothesized target were used to quantify the observed structures. Results did not support the circumplex model as a universal structure. A circular structure with axes of activation and valence was approximated only among more affectively differentiated groups: students and respondents with high scores on Openness to Feelings and measures of negative emotionality. A different structure, with unipolar Positive Affect and Negative Affect factors, was observed among adults and respondents with low Openness to Feelings and negative emotionality. The observed structure of affect will depend in part on the nature of the sample studied., Keywords: emotions, individuality, personality inventory, psychometrics, temperament, Uncontrolled subjects: Adolescent, Adult, Affect, Aged, Aged, 80 and over, Emotions, Female, Humans, Individuality, Male, Middle Aged, Personality Inventory, Psychometrics, Reproducibility of Results, Sampling Studies, Sex Factors, Students, Temperament, Note: Published in final edited form as: J Pers. 2003 October; 71(5): 669–703., Citation: Terracciano A, McCrae RR, Hagemann D, & Costa PT Jr. (2003). Individual difference variables, affective differentiation, and the structures of affect. Journal of Personality, 71, 669-703.

: Internal Consistency, Retest Reliability, and Their Implications for Personality Scale Validity; The authors examined data (N = 34,108) on the differential reliability and validity of facet scales from the NEO Inventories. They evaluated the extent to which (a) psychometric properties of facet scales are generalizable across ages, cultures, and methods of measurement, and, (b) validity criteria are associated with different forms of reliability. Composite estimates of facet scale stability, heritability, and cross-observer validity were broadly generalizable. Two estimates of retest reliability were independent predictors of the three validity criteria; none of three estimates of internal consistency was. Available evidence suggests the same pattern of results for other personality inventories. Internal consistency of scales can be useful as a check on data quality but appears to be of limited utility for evaluating the potential validity of developed scales, and it should not be used as a substitute for retest reliability. Further research on the nature and determinants of retest reliability is needed., Keywords: Reliability, validity, cross-national, Five-Factor Model, personality traits, Uncontrolled subjects: Age Factors, Character, Cross-Cultural Comparison, Humans, Personality Inventory, Psychometrics, Reproducibility of Results, Research, Note: Published in final edited form as: Pers Soc Psychol Rev. 2011 February; 15(1): 28–50. Published online 2010 April 30. doi: 10.1177/1088868310366253, Citation: McCrae RR, Kurtz JE, Yamagata S, & Terracciano A (2011). Internal consistency, retest reliability, and their implications for personality scale validity. Personality and Social Psychology Review, 15, 28-50.

: Intra-Individual Change in Personality Stability and Age; The stability of individual differences in personality traits is typically examined at the group level with test-retest correlations across two assessments. For 684 subjects (age range 17-76) we computed individual coefficients from three sequential assessments to evaluate intra-individual (i.e., within-person) change in stability over time. For both trait and profile (ipsative) stability, results indicate that intra-individual stability increases up to age 30 and then plateaus. Neither demographic variables (sex, ethnicity, education, and secular trends), nor the standing on the five major dimensions of personality, were predictors of change in trait stability. Contrary to results from studies of adolescents, personality "maturity" was unrelated to personality stability in adulthood. These findings support the notion that personality stability plateaus early in adulthood., Keywords: personality, change, stability, longitudinal, intra-individual, GZTS, NEO-PI-R, Note: Published in final edited form as: J Res Pers. 2010 February 1; 44(1): 31–37. doi: 10.1016/j.jrp.2009.09.006, Citation: Terracciano A, McCrae RR, & Costa PT Jr. (2010). Intra-individual change in personality stability and age. Journal of Research in Personality, 44, 31-37.

: Is neuroticism differentially associated with risk of Alzheimer's disease, vascular dementia, and frontotemporal dementia?

: Italian Version of the NEO PI-R; Earlier cross-cultural research on replicability of the Revised NEO Personality Inventory (NEO-PI-R) suggested that personality trait structure is universal, but a recent study using an Italian translation has challenged this position. The present article reexamines the psychometric properties of the Italian NEO-PI-R and discusses the importance of orthogonal Procrustes rotation when the replicability of complex factor structures is tested. The arguments are supported by data from a slightly modified translation of the NEO-PI-R, which was administered to 575 Italian subjects. These data show a close replication of the American normative factor structure when targeted rotation is used. Further, the validity of the Italian NEO-PI-R is supported by external correlates, such as demographic variables (age, sex, education), depression, and affect scales., Keywords: Procrustes rotation, NEO-PI-R, rotational variants, cross-cultural, validity, PANAS, CES-D, Note: Published in final edited form as: Pers Individ Dif. 2003; 35(8): 1859–1872. doi: 10.1016/S0191-8869(03)00035-7, Citation: Terracciano A (2003). The Italian version of the NEO-PI-R: Conceptual and empirical support for the use of targeted rotation. Personality and Individual Differences, 35, 1859-1872.

: Longevity Candidate Genes and Their Association with Personality Traits in the Elderly; Human longevity and personality traits are both heritable and are consistently linked at the phenotypic level. We test the hypothesis that candidate genes influencing longevity in lower organisms are associated with variance in the five major dimensions of human personality (measured by the NEO-FFI and IPIP inventories) plus related mood states of anxiety and depression. Seventy single nucleotide polymorphisms (SNPs) in six brain expressed, longevity candidate genes (AFG3L2, FRAP1, MAT1A, MAT2A, SYNJ1, and SYNJ2) were typed in over 1,000 70-year old participants from the Lothian Birth Cohort of 1936 (LBC1936). No SNPs were associated with the personality and psychological distress traits at a Bonferroni corrected level of significance (P < 0.0002), but there was an over-representation of nominally significant (P < 0.05) SNPs in the synaptojanin-2 (SYNJ2) gene associated with agreeableness and symptoms of depression. Eight SNPs which showed nominally significant association across personality measurement instruments were tested in an extremely large replication sample of 17,106 participants. SNP rs350292, in SYNJ2, was significant: the minor allele was associated with an average decrease in NEO agreeableness scale scores of 0.25 points, and 0.67 points in the restricted analysis of elderly cohorts (most aged >60 years). Because we selected a specific set of longevity genes based on functional genomics findings, further research on other longevity gene candidates is warranted to discover whether they are relevant candidates for personality and psychological distress traits., Keywords: NEO personality, IPIP personality, anxiety, depressive symptoms, ageing, genetics, Uncontrolled subjects: Adolescent, Adult, Aged, Aged, 80 and over, Alleles, Anxiety Disorders, Cohort Studies, Depression, Female, Genetic Markers, Genotype, Haplotypes, Humans, Longevity, Male, Middle Aged, Personality Disorders, Personality Tests, Phenotype, Phosphoric Monoester Hydrolases, Polymerase Chain Reaction, Polymorphism, Single Nucleotide, Young Adult, Note: Published in final edited form as: Am J Med Genet B Neuropsychiatr Genet. 2012 March; 159B(2): 192–200. Published online 2011 December 27. doi: 10.1002/ajmg.b.32013, Citation: Luciano M, Lopez LM, de Moor MH, Harris SE, Davies G, Nutile T, Krueger RF, Esko T, Schlessinger D, Toshiko T, Derringer JL, Realo A, Hansell NK, Pergadia ML, Pesonen AK, Sanna S, Terracciano A, Madden PA, Penninx B, Spinhoven P, Hartman CA, Oostra BA, Janssens AC, Eriksson JG, Starr JM, Cannas A, Ferrucci L, Metspalu A, Wright MJ, Heath AC, van Duijn CM, Bierut LJ, Raikkonen K, Martin NG, Ciullo M, Rujescu D, Boomsma DI, & Deary IJ (2012). Longevity candidate genes and their association with personality traits in the elderly. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, 159B, 192-200.

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