Association of primary lifetime occupational cognitive complexity and cognitive decline in a diverse cohort: Results from the KHANDLE study

Introduction: Higher occupational complexity has been linked to favorable cognitive outcomes, but rarely examined in racially and ethnically diverse populations. Methods: In a diverse cohort (n = 1536), linear mixed-effects models estimated associations between main lifetime occupational complexity and domain-specific cognitive decline (z-standardized). Occupational complexity with data, people, and things were classified using the Dictionary of Occupational Titles. Results: For occupational complexity with data, highest tertile (vs. lowest) was associated with higher baseline executive function (β = 0.11; 95% confidence interval [CI] 0.00–0.22) and slower annual rate of decline (β = 0.03; 95% CI 0.01–0.06), and higher baseline semantic memory (β = 0.14; 95% CI 0.04–0.25). Highest tertile of occupational complexity with people was associated with higher baseline executive function (β = 0.29; 95% CI 0.18–0.40), verbal episodic memory (β = 0.12; 95% CI 0.00–0.24), and semantic memory (β = 0.23; 95% CI 0.12–0.34). Discussion: In a diverse cohort, higher occupational complexity is associated with better cognition. Findings should be verified in larger cohorts. Highlight: Few studies have examined associations of occupational complexity with cognition in diverse populations. Racial and ethnic minorities are disproportionately exposed to lower occupational complexity. Occupational complexity with data and people are associated with better cognition.