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Rotblatt LJ, Aiken-Morgan AT, Marsiske M, Horgas AL, Thomas KR. Do Associations Between Vascular Risk and Mild Cognitive Impairment Vary by Race? J Aging Health 2023; 35:74S-83S. [PMID: 33497299 PMCID: PMC8310897 DOI: 10.1177/0898264320984357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: Given prevalence differences of mild cognitive impairment (MCI) among Black and white older adults, this study aimed to examine whether overall vascular risk factor (VRF) burden and individual VRF associations with amnestic (aMCI) and nonamnestic (naMCI) MCI status varied by Black/white race. Methods: Participants included 2755 older adults without dementia from the ACTIVE study. Comprehensive neuropsychological criteria were used to classify cognitively normal, aMCI, and naMCI. VRFs were primarily defined using subjective report and medication data. Multinomial logistic regression was run predicting MCI subtype. Results: Greater overall VRF burden, high cholesterol, and obesity evinced greater odds of naMCI in Black participants than whites. Across participants, diabetes and hypertension were associated with increased odds of aMCI and naMCI, respectively. Discussion: Results may reflect known systemic inequities on dimensions of social determinants of health for Black older adults. Continued efforts toward examining underlying mechanisms contributing to these findings are critical.
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Affiliation(s)
- Lindsay J. Rotblatt
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Ann L. Horgas
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL
| | - Kelsey R. Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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Hill-Jarrett TG. The Black radical imagination: a space of hope and possible futures. Front Neurol 2023; 14:1241922. [PMID: 37808484 PMCID: PMC10557459 DOI: 10.3389/fneur.2023.1241922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
The radical imagination entails stepping outside the confines of the now and into the expansiveness of what could be. It has been described as the ability to dream of possible futures and bring these possibilities back to the present to drive social transformation. This perspective paper seeks to provide an overview of the radical imagination and its intersections with Afrofuturism, a framework and artistic epistemology that expresses the Black cultural experience through a space of hope where Blackness is integral. In this paper, I propose three processes that comprise the radical imagination: (1) imagining alternative Black futures, (2) radical hope, and (3) collective courage. I consider the neural networks that underlie each process and consider how the Black radical imagination is a portal through which aging Black adults experience hope and envision futures that drive social change. I conclude with considerations of what brain health and healing justice looks like for aging Black Americans- specifically, how invocation of the Black radical imagination may have positive brain health effects for a demographic group at increased risk for Alzheimer's disease and related dementias.
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Affiliation(s)
- Tanisha G. Hill-Jarrett
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Mejía-Guevara I, Periyakoil VS. Childhood Bullying as a Risk Factor for Late-Life Psychological Distress and Cognitive Impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.04.23295046. [PMID: 37732246 PMCID: PMC10508796 DOI: 10.1101/2023.09.04.23295046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
In the United States, non-Hispanic Black (19%) older adults are more likely to develop dementia than White older adults (10%). As genetics alone cannot account for these differences, the impact of historical social factors is considered. This study examined whether childhood and late-life psychological distress associated with dementia risk could explain part of these disparities. Using longitudinal data from 379 White and 141 Black respondents from the Panel Study of Income Dynamics, we assessed the association between childhood bullying and late-life dementia risk, testing for mediation effects from late-life psychological distress. Mediation analysis was computed via negative binomial regression modeling, stratified by race (White/Black), type of bullying experience (target, bully, and bully-target), and the age range at which the experience occurred (6-12, 13-16). The results indicated that late-life psychological distress fully mediated the association between Black respondents who were bullies and dementia risk. However, no significant association was observed among White respondents. These results suggest that interventions aimed at preventing and treating psychological distress throughout the lifespan could be crucial in mitigating the development and progression of dementia risk.
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Strong RW, Grashow R, Roberts AL, Passell E, Scheuer L, Terry DP, Cohan S, Pascual-Leone A, Weisskopf MG, Zafonte RD, Germine LT. Association of Retrospectively Reported Concussion Symptoms with Objective Cognitive Performance in Former American-Style Football Players. Arch Clin Neuropsychol 2023; 38:875-890. [PMID: 36861317 DOI: 10.1093/arclin/acad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Sustaining concussions has been linked to health issues later in life, yet evidence for associations between contact sports exposure and long-term cognitive performance is mixed. This cross-sectional study of former professional American-style football players tested the association of several measures of football exposure with later life cognitive performance, while also comparing the cognitive performance of former players to nonplayers. METHODS In total, 353 former professional football players (Mage = 54.3) completed both (1) an online cognitive test battery measuring objective cognitive performance and (2) a survey querying demographic information, current health conditions, and measures of past football exposure, including recollected concussion symptoms playing professional football, diagnosed concussions, years of professional play, and age of first football exposure. Testing occurred an average of 29 years after former players' final season of professional play. In addition, a comparison sample of 5,086 male participants (nonplayers) completed one or more cognitive tests. RESULTS Former players' cognitive performance was associated with retrospectively reported football concussion symptoms (rp = -0.19, 95% CI -0.09 to -0.29; p < 0.001), but not with diagnosed concussions, years of professional play, or age of first football exposure. This association could be due to differences in pre-concussion cognitive functioning, however, which could not be estimated based on available data. CONCLUSIONS Future investigations of the long-term outcomes of contact sports exposure should include measures of sports-related concussion symptoms, which were more sensitive to objective cognitive performance than other football exposure measures, including self-reported diagnosed concussions.
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Affiliation(s)
- Roger W Strong
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eliza Passell
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Douglas P Terry
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cohan
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Ross D Zafonte
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Towfighi A, Berger RP, Corley AMS, Glymour MM, Manly JJ, Skolarus LE. Recommendations on Social Determinants of Health in Neurologic Disease. Neurology 2023; 101:S17-S26. [PMID: 37580147 DOI: 10.1212/wnl.0000000000207562] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
Social determinants of health (SDOH) are increasingly recognized as important drivers of inequities in neurologic disease and outcomes. However, our understanding of the biopsychosocial mechanisms by which SDOH affect neurologic disease remains in its infancy. The most robust epidemiologic research has been on the associations between education, schooling, and place-based social determinants on cognition, dementia, and cerebrovascular disease later in life. Further research is needed to more deeply understand the complex interplay of SDOH on neurologic disease. Few SDOH screening tools have been validated in populations with neurologic disease. In addition, comparison across studies and populations is hampered by lack of standardized common data elements. Experiences of populations historically underrepresented in research should be centered in future research studies, and changes should be made in recruitment expectations and measurement choices. For research on inequities, it is critical to support and incentivize institutional infrastructure to foster meaningful engagement with populations affected by research. Finally, it remains to be seen whether individual-level health or behavioral interventions or place-level, systemic or policy interventions to reduce population burden will be most effective in reducing inequities in neurologic disease and outcomes. Although numerous clinical trials have focused on addressing downstream SDOH such as health literacy and health behaviors (e.g., medication adherence, physical activity, diet), few have addressed upstream, structural determinants which may have a more profound impact on addressing inequities in neurologic disease. Ultimately, further research is needed to determine which specific SDOH should be targeted and how, when, and by whom they should be addressed to improve neurologic outcomes.
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Affiliation(s)
- Amytis Towfighi
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL.
| | - Rachel P Berger
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - Alexandra M S Corley
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - M Maria Glymour
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - Jennifer J Manly
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - Lesli E Skolarus
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
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Kim J, Kwon KY. Investigating Heterogeneity in the Relationship Between Marital Satisfaction and Cognitive Health by Gender and Across the Cognitive Function Distribution. Innov Aging 2023; 7:igad079. [PMID: 37727598 PMCID: PMC10506168 DOI: 10.1093/geroni/igad079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 09/21/2023] Open
Abstract
Background and Objectives Marital satisfaction has been established as an essential factor for promoting health and well-being in older adults. However, it is unclear whether marital satisfaction is also associated with cognitive health in this population. This study aimed to investigate the longitudinal association between marital satisfaction and cognitive function, while also exploring variations in this relationship by gender and across the cognitive function distribution. Research Design and Methods This study used 6 waves of the Korean Longitudinal Study of Ageing (KLoSA) and employed gender-stratified unconditional quantile regression (UQR) models with fixed effects (FE) to estimate the association between marital satisfaction and cognitive function across different quantiles of the cognitive function distribution. FE models controlled for unobserved individual-level confounders such as genetics, cognitive and noncognitive skills, and early childhood social and cultural background. Results The results of this study revealed that marital satisfaction was positively associated with cognitive function (b = 0.305), and this association was stronger in older men than in older women (b = 0.392 for older men vs b = 0.181 for older women). The UQR-FE models suggested that stronger association between marital satisfaction and cognitive function was observed among older men with lower cognitive function (b = 0.817 for 10th percentile vs b = 0.118 for 90th percentile). Among older women, no clear patterns of heterogeneity were found across the cognitive function distribution. Discussion and Implications The findings of this study highlight a significant degree of heterogeneity in the relationship between marital satisfaction and cognitive function among older men, with stronger associations observed in the lower percentiles of the cognitive function distribution. Interventions aimed at improving marital quality could be an effective strategy for promoting cognitive health in older adults, with an approach tailored to the individual's characteristics.
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Affiliation(s)
- Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Keun Young Kwon
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
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Modeste ES, Ping L, Watson CM, Duong DM, Dammer EB, Johnson ECB, Roberts BR, Lah JJ, Levey AI, Seyfried NT. Quantitative proteomics of cerebrospinal fluid from African Americans and Caucasians reveals shared and divergent changes in Alzheimer's disease. Mol Neurodegener 2023; 18:48. [PMID: 37468915 PMCID: PMC10355042 DOI: 10.1186/s13024-023-00638-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Despite being twice as likely to get Alzheimer's disease (AD), African Americans have been grossly underrepresented in AD research. While emerging evidence indicates that African Americans with AD have lower cerebrospinal fluid (CSF) levels of Tau compared to Caucasians, other differences in AD CSF biomarkers have not been fully elucidated. Here, we performed unbiased proteomic profiling of CSF from African Americans and Caucasians with and without AD to identify both common and divergent AD CSF biomarkers. METHODS Multiplex tandem mass tag-based mass spectrometry (TMT-MS) quantified 1,840 proteins from 105 control and 98 AD patients of which 100 identified as Caucasian while 103 identified as African American. We used differential protein expression and co-expression approaches to assess how changes in the CSF proteome are related to race and AD. Co-expression network analysis organized the CSF proteome into 14 modules associated with brain cell-types and biological pathways. A targeted mass spectrometry method, selected reaction monitoring (SRM), with heavy labeled internal standards was used to measure a panel of CSF module proteins across a subset of African Americans and Caucasians with or without AD. A receiver operating characteristic (ROC) curve analysis assessed the performance of each protein biomarker in differentiating controls and AD by race. RESULTS Consistent with previous findings, the increase of Tau levels in AD was greater in Caucasians than in African Americans by both immunoassay and TMT-MS measurements. CSF modules which included 14-3-3 proteins (YWHAZ and YWHAG) demonstrated equivalent disease-related elevations in both African Americans and Caucasians with AD, whereas other modules demonstrated more profound disease changes within race. Modules enriched with proteins involved with glycolysis and neuronal/cytoskeletal proteins, including Tau, were more increased in Caucasians than in African Americans with AD. In contrast, a module enriched with synaptic proteins including VGF, SCG2, and NPTX2 was significantly lower in African Americans than Caucasians with AD. Following SRM and ROC analysis, VGF, SCG2, and NPTX2 were significantly better at classifying African Americans than Caucasians with AD. CONCLUSIONS Our findings provide insight into additional protein biomarkers and pathways reflecting underlying brain pathology that are shared or differ by race.
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Affiliation(s)
- Erica S. Modeste
- School of Medicine, Department of Biochemistry, Emory University, Atlanta, GA USA
| | - Lingyan Ping
- School of Medicine, Department of Biochemistry, Emory University, Atlanta, GA USA
| | - Caroline M. Watson
- School of Medicine, Department of Neurology, Emory University, Atlanta, GA USA
| | - Duc M. Duong
- School of Medicine, Department of Biochemistry, Emory University, Atlanta, GA USA
| | - Eric B. Dammer
- School of Medicine, Department of Biochemistry, Emory University, Atlanta, GA USA
| | - Erik C. B. Johnson
- School of Medicine, Department of Neurology, Emory University, Atlanta, GA USA
| | - Blaine R. Roberts
- School of Medicine, Department of Biochemistry, Emory University, Atlanta, GA USA
| | - James J. Lah
- School of Medicine, Department of Neurology, Emory University, Atlanta, GA USA
| | - Allan I. Levey
- School of Medicine, Department of Neurology, Emory University, Atlanta, GA USA
| | - Nicholas T. Seyfried
- School of Medicine, Department of Biochemistry, Emory University, Atlanta, GA USA
- School of Medicine, Department of Neurology, Emory University, Atlanta, GA USA
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Simon SS, Brucki SMD, Fonseca LM, Becker J, Cappi C, Marques AH, Heyn PC, Gonçalves PD, Martins SS, Busatto G, Bertola L, Suemoto CK, Nitrini R, Caramelli P, Yassuda MS, Miotto EC, Grinberg LT, Arce Renteria M, Alegria M, Stern Y, Rivera‐Mindt M. The (in)visible Brazilians: A perspective review on the need for brain health and dementia research with Brazilian immigrants in the United States. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12425. [PMID: 37744309 PMCID: PMC10517444 DOI: 10.1002/trc2.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/26/2023]
Abstract
Introduction The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group-specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities.It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population. Methods We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles. Results This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S-residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials. Conclusions The recommendation and research efforts proposed should help to pave the way for the development of community-engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally-informed intervention to the U.S.-residing Brazilian communities. HIGHLIGHTS The Brazilian population in the United States is growing but is underrepresented in U.S. health research.Approximately 71% of Brazilian immigrants in the United States are undocumented, with an increased risk for health inequities.Mental health is reported as a central health priority by Brazilian immigrants in the United States.There is a lack of research on Alzheimer's disease and other dementias (ADRD) in Brazilian immigrants in the United States.Epidemiological research is needed to map the prevalence/incidence of mental health conditions and ADRD risk factors among Brazilian immigrants in the United States.
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Affiliation(s)
- Sharon Sanz Simon
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | | | - Luciana Mascarenhas Fonseca
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Department of Community and Behavioral HealthElson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
| | - Jacqueline Becker
- Division of General Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carolina Cappi
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of PsychiatryClinics HospitalUniversity of São PauloSchool of MedicineSão PauloSão PauloBrazil
| | - Andrea Horvath Marques
- Elliott School International AffairsThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Patricia C. Heyn
- Center for Optimal AgingDepartment of Physical TherapyMarymount UniversityArlingtonVirginiaUSA
| | - Priscila Dib Gonçalves
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Silvia S. Martins
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Geraldo Busatto
- Laboratory of Psychiatric Neuroimaging (LIM‐21)Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Laiss Bertola
- Department of PsychiatryEscola Paulista de Medicina, Universidade Federal de São PauloSão PauloBrazil
| | - Claudia Kimie Suemoto
- Division of GeriatricsDepartment of Clinical MedicineUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Ricardo Nitrini
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research GroupFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Monica Sanches Yassuda
- Department of NeurologyUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Gerontology, School of Arts, Sciences, and HumanitiesUniversity of São PauloSão PauloSão PauloBrazil
| | - Eliane Correa Miotto
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Lea Tenenholz Grinberg
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- LIM‐22Department of PathologyUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Miguel Arce Renteria
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Margarita Alegria
- Disparities Research UnitDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Yaakov Stern
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Monica Rivera‐Mindt
- Department of PsychologyFordham UniversityNew YorkNew YorkUSA
- Department of NeurologyIcahn School of MedicineNew YorkNew YorkUSA
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Casagrande CC, Rempe MP, Springer SD, Wilson TW. Comprehensive review of task-based neuroimaging studies of cognitive deficits in Alzheimer's disease using electrophysiological methods. Ageing Res Rev 2023; 88:101950. [PMID: 37156399 PMCID: PMC10261850 DOI: 10.1016/j.arr.2023.101950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
With an aging population, cognitive decline and neurodegenerative disorders are an emerging public health crises with enormous, yet still under-recognized burdens. Alzheimer's disease (AD) is the most common type of dementia, and the number of cases is expected to dramatically rise in the upcoming decades. Substantial efforts have been placed into understanding the disease. One of the primary avenues of research is neuroimaging, and while positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are most common, crucial recent advancements in electrophysiological methods such as magnetoencephalography (MEG) and electroencephalography (EEG) have provided novel insight into the aberrant neural dynamics at play in AD pathology. In this review, we outline task-based M/EEG studies published since 2010 using paradigms probing the cognitive domains most affected by AD, including memory, attention, and executive functioning. Furthermore, we provide important recommendations for adapting cognitive tasks for optimal use in this population and adjusting recruitment efforts to improve and expand future neuroimaging work.
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Affiliation(s)
- Chloe C Casagrande
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Maggie P Rempe
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA; College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Seth D Springer
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA; College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE 68178, USA.
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Savold J, Cole M, Thorpe RJ. Barriers and solutions to Alzheimer's disease clinical trial participation for Black Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12402. [PMID: 37408664 PMCID: PMC10318422 DOI: 10.1002/trc2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
Introduction Black Americans are disproportionately burdened by Alzheimer's disease (AD) relative to other racial groups in the United States and continue to be underrepresented in AD clinical trials. This review explores the primary barriers for participation in clinical trials among Black Americans and provides literature-based recommendations to improve the inclusion of Black Americans in AD clinical trials. Methods We searched electronic databases and gray literature for articles published in the United States through January 1, 2023, ultimately identifying 26 key articles for inclusion. Results Barriers to participation in clinical trials for Black Americans are rooted in social determinants of health, including access to quality education and information, access to health care, economic stability, built environment, and community context. Best practices to improve the inclusion of Black Americans in clinical trials require pharmaceutical companies to adopt a multifaceted approach, investing in innovative strategies for site selection, development of local partnerships, outreach, and education. Discussion While multisectoral action must occur to effectively address the disproportionate burden of AD on Black Americans, the pharmaceutical industry has an important part to play in this space due to their central role in product development and clinical trials.
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Affiliation(s)
- Jordan Savold
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michele Cole
- Global Market Access, Neuroscience Therapeutic AreaJohnson & JohnsonRaritanNew JerseyUSA
| | - Roland J. Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging ResearchBaltimoreMarylandUSA
- Johns Hopkins Center for Health Disparities SolutionsBaltimoreMarylandUSA
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Scalco R, Saito N, Beckett L, Nguyen ML, Huie E, Wang HP, Flaherty DA, Honig LS, DeCarli C, Rissman RA, Teich AF, Jin LW, Dugger BN. The neuropathological landscape of Hispanic and non-Hispanic White decedents with Alzheimer disease. Acta Neuropathol Commun 2023; 11:105. [PMID: 37386610 PMCID: PMC10311731 DOI: 10.1186/s40478-023-01574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/30/2023] [Indexed: 07/01/2023] Open
Abstract
Despite the increasing demographic diversity of the United States' aging population, there remain significant gaps in post-mortem research investigating the ethnoracial heterogeneity in the neuropathological landscape of Alzheimer Disease (AD). Most autopsy-based studies have focused on cohorts of non-Hispanic White decedents (NHWD), with few studies including Hispanic decedents (HD). We aimed to characterize the neuropathologic landscape of AD in NHWD (n = 185) and HD (n = 92) evaluated in research programs across three institutions: University of California San Diego, University of California Davis, and Columbia University. Only persons with a neuropathologic diagnosis of intermediate/high AD determined by NIA Reagan and/or NIA-AA criteria were included. A frequency-balanced random sample without replacement was drawn from the NHWD group using a 2:1 age and sex matching scheme with HD. Four brain areas were evaluated: posterior hippocampus, frontal, temporal, and parietal cortices. Sections were stained with antibodies against Aβ (4G8) and phosphorylated tau (AT8). We compared the distribution and semi-quantitative densities for neurofibrillary tangles (NFTs), neuropil threads, core, diffuse, and neuritic plaques. All evaluations were conducted by an expert blinded to demographics and group status. Wilcoxon's two-sample test revealed higher levels of neuritic plaques in the frontal cortex (p = 0.02) and neuropil threads (p = 0.02) in HD, and higher levels of cored plaques in the temporal cortex in NHWD (p = 0.02). Results from ordinal logistic regression controlling for age, sex, and site of origin were similar. In other evaluated brain regions, semi-quantitative scores of plaques, tangles, and threads did not differ statistically between groups. Our results demonstrate HD may be disproportionately burdened by AD-related pathologies in select anatomic regions, particularly tau deposits. Further research is warranted to understand the contributions of demographic, genetic, and environmental factors to heterogeneous pathological presentations.
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Affiliation(s)
- Rebeca Scalco
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Laurel Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - My-Le Nguyen
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Emily Huie
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Hsin-Pei Wang
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Delaney A Flaherty
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Lawrence S Honig
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Charles DeCarli
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Andrew F Teich
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Lee-Way Jin
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA.
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Higgins Tejera C, Ware EB, Kobayashi LC, Fu M, Hicken M, Zawistowski M, Mukherjee B, Bakulski KM. Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study. Front Hum Neurosci 2023; 17:1052435. [PMID: 37323925 PMCID: PMC10267311 DOI: 10.3389/fnhum.2023.1052435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background and objectives Elevated circulating cystatin C is associated with cognitive impairment in non-Hispanic Whites, but its role in racial disparities in dementia is understudied. In a nationally representative sample of older non-Hispanic White, non-Hispanic Black, and Hispanic adults in the United States, we use mediation-interaction analysis to understand how racial disparities in the cystatin C physiological pathway may contribute to racial disparities in prevalent dementia. Methods In a pooled cross-sectional sample of the Health and Retirement Study (n = 9,923), we employed Poisson regression to estimate prevalence ratios and to test the relationship between elevated cystatin C (>1.24 vs. ≤1.24 mg/L) and impaired cognition, adjusted for demographics, behavioral risk factors, other biomarkers, and chronic conditions. Self-reported racialized social categories were a proxy measure for exposure to racism. We calculated additive interaction measures and conducted four-way mediation-interaction decomposition analysis to test the moderating effect of race/ethnicity and mediating effect of cystatin C on the racial disparity. Results Overall, elevated cystatin C was associated with dementia (prevalence ratio [PR] = 1.2; 95% CI: 1.0, 1.5). Among non-Hispanic Black relative to non-Hispanic White participants, the relative excess risk due to interaction was 0.7 (95% CI: -0.1, 2.4), the attributable proportion was 0.1 (95% CI: -0.2, 0.4), and the synergy index was 1.1 (95% CI: 0.8, 1.8) in a fully adjusted model. Elevated cystatin C was estimated to account for 2% (95% CI: -0, 4%) for the racial disparity in prevalent dementia, and the interaction accounted for 8% (95% CI: -5, 22%). Analyses for Hispanic relative to non-white participants suggested moderation by race/ethnicity, but not mediation. Discussion Elevated cystatin C was associated with dementia prevalence. Our mediation-interaction decomposition analysis suggested that the effect of elevated cystatin C on the racial disparity might be moderated by race/ethnicity, which indicates that the racialization process affects not only the distribution of circulating cystatin C across minoritized racial groups, but also the strength of association between the biomarker and dementia prevalence. These results provide evidence that cystatin C is associated with adverse brain health and this effect is larger than expected for individuals racialized as minorities had they been racialized and treated as non-Hispanic White.
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Affiliation(s)
- César Higgins Tejera
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Erin B. Ware
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Lindsay C. Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Mingzhou Fu
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Margaret Hicken
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Matthew Zawistowski
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Kelly M. Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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Cicero EC, Lett E, Flatt JD, Benson GP, Epps F. Transgender Adults From Minoritized Ethnoracial Groups in the U.S. Report Greater Subjective Cognitive Decline. J Gerontol B Psychol Sci Soc Sci 2023; 78:1051-1059. [PMID: 36688593 PMCID: PMC10214655 DOI: 10.1093/geronb/gbad012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Investigate subjective cognitive decline (SCD) among 4 study groups consisting of cisgender and transgender adults who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial transgender, minoritized ethnoracial cisgender) and White cisgender and transgender adults aged 45+ (i.e., White transgender, White cisgender) to determine the odds of SCD by group and to test for group differences. METHODS Data from the 2015-2020 Behavioral Risk Factor Surveillance System were used in a modified case-control approach to perform an intercategorical intersectional study. Each transgender participant was matched to 2 cisgender men and 2 cisgender women, on state, ethnoracial identity, and age. Multivariable logistic regressions modeled SCD odds by group and post hoc contrasts estimated pairwise odds ratios comparing the SCD odds for each combination of groups. RESULTS SCD prevalence was highest among minoritized ethnoracial transgender (21.6%), followed by White transgender (15.0%), minoritized ethnoracial cisgender (12.0%), and White cisgender (9.0%). After accounting for age, education, and survey year, the odds of SCD were higher in minoritized ethnoracial transgender when compared to White cisgender (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.59-3.96) and minoritized ethnoracial cisgender (aOR = 1.89, 95% CI: 1.16-3.09). The odds of SCD were higher in White transgender compared to White cisgender (aOR = 1.66, 95% CI: 1.20-2.30). DISCUSSION When considering the intersection of transgender and ethnoracial identities, we found that transgender adults from minoritized ethnoracial groups reported higher odds of SCD when compared to cisgender adults from minoritized ethnoracial groups. Additional studies are needed to understand the relationship between racialized and gendered inequities in cognitive impairment and how specific mechanisms of systemic transphobia and racism may contribute to this inequity.
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Affiliation(s)
- Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Jason D Flatt
- School of Public Health, Department of Social and Behavioral Health Program, University of Nevada, Las Vegas, Nevada, USA
| | - G Perusi Benson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Di Luca DG, Luo S, Liu H, Cohn M, Davis TL, Ramirez-Zamora A, Rafferty M, Dahodwala N, Naito A, Neault M, Beck J, Marras C. Racial and Ethnic Differences in Health-Related Quality of Life for Individuals With Parkinson Disease Across Centers of Excellence. Neurology 2023; 100:e2170-e2181. [PMID: 37019661 PMCID: PMC10238163 DOI: 10.1212/wnl.0000000000207247] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/16/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Racial and ethnic minorities have been underrepresented in Parkinson disease (PD) research, limiting our understanding of treatments and outcomes across all non-White groups. The goal of this research is to investigate variability in health-related quality of life (HRQoL) and other outcomes in patients with PD across different races and ethnicities. METHODS This was a retrospective, cross-sectional and longitudinal, cohort study of individuals evaluated at PD Centers of Excellence. A multivariable regression analysis adjusted for sex, age, disease duration, Hoehn and Yahr (H&Y) stage, comorbidities, and cognitive score was used to investigate differences between racial and ethnic groups. A multivariable regression with skewed-t errors was performed to assess the individual contribution of each variable to the association of 39-item PD Questionnaire (PDQ-39) with race and ethnicity. RESULTS A total of 8,514 participants had at least 1 recorded visit. Most of them (90.2%) self-identified as White (n = 7,687), followed by 5.81% Hispanic (n = 495), 2% Asians (n = 170), and 1.9% African American (n = 162). After adjustment, total PDQ-39 scores were significantly higher (worse) in African Americans (28.56), Hispanics (26.62), and Asians (25.43) when compared with those in White patients (22.73, p < 0.001). This difference was also significant in most PDQ-39 subscales. In the longitudinal analysis, the inclusion of cognitive scores significantly decreased the strength of association of the PDQ-39 and race/ethnicity for minority groups. A mediation analysis demonstrated that cognition partially mediated the association between race/ethnicity and PDQ-39 scores (proportion mediated 0.251, p < 0.001). DISCUSSION There were differences in PD outcomes across racial and ethnic groups, even after adjustment for sex, disease duration, HY stage, age, and some comorbid conditions. Most notably, there was worse HRQoL among non-White patients when compared with White patients, which was partially explained by cognitive scores. The underlying reason for these differences needs to be a focus of future research.
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Affiliation(s)
- Daniel Garbin Di Luca
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Sheng Luo
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Hongliang Liu
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Melanie Cohn
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Thomas L Davis
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Adoldo Ramirez-Zamora
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Miriam Rafferty
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Nabila Dahodwala
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Anna Naito
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Marilyn Neault
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - James Beck
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY
| | - Connie Marras
- From the Edmond J. Safra Program in Parkinson's Disease (D.G.D.L., C.M.), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (D.G.D.L., C.M.), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Biostatistics and Bioinformatics (S.L., H.L.), Duke University, Durham, NC; Krembil Brain Institute (M.C.), Toronto Western Hospital, Ontario, Canada; Department of Neurology (T.L.D.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (A.R.-Z.), Fixel Neurological Institute, University of Florida, Gainesville; Shirley Ryan Ability Lab (M.R.), Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL; Department of Neurology (N.D.), University of Pennsylvania, Philadelphia; and Parkinson's Foundation (A.N., M.N., J.B.), New York, NY.
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Harris ML, Bennion E, Magnusson KR, Howard VJ, Wadley VG, McClure LA, Levine DA, Manly JJ, Avila JF, Glymour MM, Wisco JJ, Thacker EL. Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment. Neuroepidemiology 2023; 57:218-228. [PMID: 37231876 DOI: 10.1159/000530961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/02/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Rural versus urban living is a social determinant of cognitive health. We estimated the association of rural versus urban residence in the USA with incident cognitive impairment (ICI) and assessed effect heterogeneity by sociodemographic, behavioral, and clinical factors. METHODS The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) is a population-based prospective observational cohort of 30,239 adults, 57% female, 36% Black, aged 45+ years, sampled from 48 contiguous states in the USA in 2003-2007. We analyzed 20,878 participants who at baseline were cognitively intact with no history of stroke and had ICI assessed on average 9.4 years later. We classified participants' home addresses at baseline as urban (population ≥50,000), large rural (10,000-49,999), or small rural (≤9,999) by Rural-Urban Commuting Area codes. We defined ICI as ≥1.5 SD below the mean on at least 2 of the following tests: word list learning, word list delayed recall, and animal naming. RESULTS Participants' home addresses were 79.8% urban, 11.7% large rural, and 8.5% small rural. ICI occurred in 1,658 participants (7.9%). Small rural residents had higher odds of ICI than urban residents, adjusted for age, sex, race, region, and education (OR = 1.34 [95% CI: 1.10, 1.64]), and after further adjustment for income, health behaviors, and clinical characteristics (OR = 1.24 [95% CI: 1.02, 1.53]). Former smoking versus never, nondrinking versus light alcohol drinking, no exercise versus ≥4 times/week, CES-D depressive symptom score of 2 versus 0, and fair versus excellent self-rated health had stronger associations with ICI in small rural areas than in urban areas. For example, in urban areas, lack of exercise was not associated with ICI (OR = 0.90 [95% CI: 0.77, 1.06]); however, lack of exercise combined with small rural residence was associated with 1.45 times the odds of ICI compared with ≥4 bouts of exercise/week in urban areas (95% CI: 1.03, 2.03). Overall, large rural residence was not associated with ICI; however, black race, hypertension, and depressive symptoms had somewhat weaker associations with ICI, and heavy alcohol drinking a stronger association with ICI, in large rural areas than in urban areas. CONCLUSION Small rural residence was associated with ICI among USA adults. Further research to better understand why rural residents are at higher risk for developing ICI and mechanisms to ameliorate that risk will support efforts to advance rural public health.
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Affiliation(s)
- Matthew L Harris
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- University at Buffalo Jacobs School of Medicine, State University of New York, Buffalo, New York, USA
| | - Erica Bennion
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristine R Magnusson
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer J Manly
- Department of Neurology, Columbia University, New York, New York, USA
| | - Justina F Avila
- Department of Neurology, Columbia University, New York, New York, USA
| | - Maria M Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jonathan J Wisco
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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Lee J, Sol K, Zaheed A, Morris E, Meister L, Palms J, Zahodne L. Coping Styles and Cognitive Function in Older Non-Hispanic Black and White Adults. J Gerontol B Psychol Sci Soc Sci 2023; 78:789-798. [PMID: 36630289 PMCID: PMC10174202 DOI: 10.1093/geronb/gbad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Coping styles refer to cognitive and behavioral patterns used to manage the demands of stressors, and effective coping represents a psychological resource. Some studies have linked coping styles to executive functioning, but less is known about coping styles and their associations with cognition across social groups known to differ in stress exposure and dementia risk. This study aimed to characterize associations between coping styles and cognitive functioning across non-Hispanic Black and non-Hispanic White older adults. METHODS Participants were drawn from the Michigan Cognitive Aging Project (N = 453; age mean (SD) = 63.6 (3.2); 53% non-Hispanic Black). Problem-focused and emotion-focused coping were measured using the Coping Orientation to Problems Experienced Inventory. Global cognition was a composite of 5 cognitive domain scores derived from comprehensive neuropsychological tests. Cross-sectional associations between coping styles and cognition were examined using race-stratified regressions controlling for demographic and health covariates. RESULTS Black older adults reported more emotion-focused coping than White older adults, but there were no race differences in problem-focused coping. Among Black older adults, less problem-focused coping and more emotion-focused coping were each associated with worse cognition. Among White older adults, emotion-focused coping was marginally linked to cognition. DISCUSSION Greater emotion-focused coping among Black older adults may reflect greater exposure to stressors that are uncontrollable. Patterns of racial differences in coping-cognition links are in line with the social vulnerabilities hypothesis. Coping style may be a particularly important psychosocial resource for cognitive health among Black older adults that could be incorporated into culturally relevant interventions.
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Affiliation(s)
- Ji Hyun Lee
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ketlyne Sol
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey M Meister
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan D Palms
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Hausman HK, Alexander GE, Cohen R, Marsiske M, DeKosky ST, Hishaw GA, O'Shea A, Kraft JN, Dai Y, Wu S, Woods AJ. Primary outcome from the augmenting cognitive training in older adults study (ACT): A tDCS and cognitive training randomized clinical trial. Brain Stimul 2023; 16:904-917. [PMID: 37245842 PMCID: PMC10436327 DOI: 10.1016/j.brs.2023.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND There is a need for effective interventions to stave off cognitive decline in older adults. Cognitive training has variably produced gains in untrained tasks and daily functioning. Combining cognitive training with transcranial direct current stimulation (tDCS) may augment cognitive training effects; however, this approach has yet to be tested on a large-scale. OBJECTIVE This paper will present the primary findings of the Augmenting Cognitive Training in Older Adults (ACT) clinical trial. We hypothesize that receiving active stimulation with cognitive training will result in greater improvements on an untrained fluid cognition composite compared to sham following intervention. METHODS 379 older adults were randomized, and 334 were included in intent-to-treat analyses for a 12-week multidomain cognitive training and tDCS intervention. Active or sham tDCS was administered at F3/F4 during cognitive training daily for two weeks then weekly for 10 weeks. To assess the tDCS effect, we fitted regression models for changes in NIH Toolbox Fluid Cognition Composite scores immediately following intervention and one year from baseline controlling for covariates and baseline scores. RESULTS Across the entire sample, there were improvements in NIH Toolbox Fluid Cognition Composite scores immediately post-intervention and one year following baseline; however, there were no significant tDCS group effects at either timepoint. CONCLUSIONS The ACT study models rigorous, safe administration of a combined tDCS and cognitive training intervention in a large sample of older adults. Despite potential evidence of near-transfer effects, we failed to demonstrate an additive benefit of active stimulation. Future analyses will continue to assess the intervention's efficacy by examining additional measures of cognition, functioning, mood, and neural markers.
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Affiliation(s)
- Hanna K Hausman
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Gene E Alexander
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Disease Consortium, Tucson, AZ, USA; Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Steven T DeKosky
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Georg A Hishaw
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Disease Consortium, Tucson, AZ, USA
| | - Andrew O'Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jessica N Kraft
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samuel Wu
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Besser LM, Jimenez MP, Reimer CJ, Meyer OL, Mitsova D, George KM, Adkins-Jackson PB, Galvin JE. Diversity of Studies on Neighborhood Greenspace and Brain Health by Racialized/Ethnic Group and Geographic Region: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5666. [PMID: 37174185 PMCID: PMC10178609 DOI: 10.3390/ijerph20095666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
Studies examining associations between greenspace and Alzheimer's disease and related dementia (ADRD) outcomes are rapidly on the rise, yet no known literature reviews have summarized the racialized/ethnic group and geographic variation of those published studies. This is a significant gap given the known disparities in both greenspace access and ADRD risk between racialized/ethnic groups and between developed versus developing countries. In this rapid literature review, we (1) describe the diversity of published greenspace-brain health studies with respect to racialized/ethnic groups and geographic regions; (2) determine the extent to which published studies have investigated racialized/ethnic group differences in associations; and (3) review methodological issues surrounding studies of racialized/ethnic group disparities in greenspace and brain health associations. Of the 57 papers meeting our inclusion criteria as of 4 March 2022, 21% (n = 12) explicitly identified and included individuals who were Black, Hispanic/Latinx, and/or Asian. Twenty-one percent of studies (n = 12) were conducted in developing countries (e.g., China, Dominican Republic, Mexico), and 7% (n = 4) examined racialized/ethnic group differences in greenspace-brain health associations. None of the studies were framed by health disparities, social/structural determinants of health, or related frameworks, despite the known differences in both greenspace availability/quality and dementia risk by racialized/ethnic group and geography. Studies are needed in developing countries and that directly investigate racialized/ethnic group disparities in greenspace-brain health associations to target and promote health equity.
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Affiliation(s)
- Lilah M. Besser
- Comprehensive Center for Brain Health, Miller School of Medicine, University of Miami, Miami, FL 33433, USA
| | - Marcia Pescador Jimenez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Cameron J. Reimer
- Department of Earth & Environment, Boston University, Boston, MA 02118, USA
| | - Oanh L. Meyer
- Department of Neurology, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Diana Mitsova
- School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Kristen M. George
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA 95817, USA
| | - Paris B. Adkins-Jackson
- Departments of Epidemiology and Sociomedical Sciences, Columbia University, New York, NY 10032, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Miller School of Medicine, University of Miami, Miami, FL 33433, USA
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Rosso AL, Troxel WM, Gary-Webb TL, Weinstein AM, Butters MA, Palimaru A, Ghosh-Dastidar B, Wagner L, Nugroho A, Hunter G, Parker J, Dubowitz T. Design of the think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and alzheimer's disease risk in disinvested, black neighborhoods. BMC Public Health 2023; 23:636. [PMID: 37013498 PMCID: PMC10069058 DOI: 10.1186/s12889-023-15381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Black Americans have disproportionately higher rates and earlier onset of Alzheimer's disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans. METHODS The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35-49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life. DISCUSSION Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US.
| | - Wendy M Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US
| | | | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, US
| | - Alina Palimaru
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - La'Vette Wagner
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Alvin Nugroho
- Survey Research Group, RAND Corporation, Santa Monica, US
| | - Gerald Hunter
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - Tamara Dubowitz
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
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Lu P, Kezios K, Milazzo F, Jawadekar N, Shelley M, Zeki Al Hazzouri A. Racial Differences in Employment and Poverty Histories and Health in Older Age. Am J Prev Med 2023; 64:543-551. [PMID: 36642644 DOI: 10.1016/j.amepre.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health. METHODS Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (NBlack=555, NWhite=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022. RESULTS More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents. CONCLUSIONS Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.
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Affiliation(s)
- Peiyi Lu
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Katrina Kezios
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Floriana Milazzo
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Neal Jawadekar
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mack Shelley
- Department of Political Science, Iowa State University, Ames, Iowa; Department of Statistics, Iowa State University, Ames, Iowa
| | - Adina Zeki Al Hazzouri
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Seblova D, Eng C, Avila‐Rieger JF, Dworkin JD, Peters K, Lapham S, Zahodne LB, Chapman B, Prescott CA, Gruenewald TL, Arpawong TE, Gatz M, Jones RJ, Glymour MM, Manly JJ. High school quality is associated with cognition 58 years later. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12424. [PMID: 37144175 PMCID: PMC10152568 DOI: 10.1002/dad2.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/16/2022] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
Abstract
We leveraged a unique school-based longitudinal cohort-the Project Talent Aging Study-to examine whether attending higher quality schools is associated with cognitive performance among older adults in the United States (mean age = 74.8). Participants (n = 2,289) completed telephone neurocognitive testing. Six indicators of high school quality, reported by principals at the time of schooling, were predictors of respondents' cognitive function 58 years later. To account for school-clustering, multilevel linear and logistic models were applied. We found that attending schools with a higher number of teachers with graduate training was the clearest predictor of later-life cognition, and school quality mattered especially for language abilities. Importantly, Black respondents (n = 239; 10.5 percentage) were disproportionately exposed to low quality high schools. Therefore, increased investment in schools, especially those that serve Black children, could be a powerful strategy to improve later life cognitive health among older adults in the United States.
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Affiliation(s)
- Dominika Seblova
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
- Second Faculty of MedicineCharles University PraguePragueCzech Republic
| | - Chloe Eng
- University of California San FranciscoDepartment of Epidemiology and BiostatisticsSan FranciscoCaliforniaUSA
| | - Justina F. Avila‐Rieger
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | | | - Kelly Peters
- American Institutes for ResearchWashingtonDistrict of ColumbiaUSA
| | - Susan Lapham
- American Institutes for ResearchWashingtonDistrict of ColumbiaUSA
| | | | | | | | | | | | - Margaret Gatz
- University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Rich J. Jones
- Brown UniversityDepartment of Psychiatry and Human Behavior & Department of NeurologyProvidenceRhode IslandUSA
| | - Maria M. Glymour
- University of California San FranciscoDepartment of Epidemiology and BiostatisticsSan FranciscoCaliforniaUSA
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
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HAYWARD MARKD, FARINA MATEOP. Dynamic Changes in the Association Between Education and Health in the United States. Milbank Q 2023; 101:396-418. [PMID: 37096600 PMCID: PMC10126982 DOI: 10.1111/1468-0009.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points We reviewed some of the recent advances in education and health, arguing that attention to social contextual factors and the dynamics of social and institutional change provide critical insights into the ways in which the association is embedded in institutional contexts. Based on our findings, we believe incorporating this perspective is fundamentally important to ameliorate current negative trends and inequality in Americans' health and longevity.
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Affiliation(s)
- MARK D. HAYWARD
- Population Research Center and Department of SociologyUniversity of Texas at Austin
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Jock J, Kobayashi L, Chakraborty R, Chen X, Wing C, Berkman L, Canning D, Kabudula CW, Tollman S, Rosenberg M. Effects of Pension Eligibility Expansion on Men's Cognitive Function: Findings from Rural South Africa. J Aging Soc Policy 2023:1-20. [PMID: 36975023 PMCID: PMC10533724 DOI: 10.1080/08959420.2023.2195785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/11/2022] [Indexed: 03/29/2023]
Abstract
Two-thirds of people living with Alzheimer's disease and related dementias (ADRD) live in low- and middle-income countries, and this figure is expected to rise as these populations are rapidly aging. Since evidence demonstrates links between socioeconomic status and slower rates of cognitive decline, protecting older adults' cognitive function in resource-limited countries that lack the infrastructure to cope with ADRD is crucial to reduce the burden it places on these populations and their health systems. While cash transfers are a promising intervention to promote healthy cognitive aging, factors such as household wealth and level of education often confound the ability to make causal inferences on the impact of cash transfers and cognitive function. This study uses a quasi-experimental design, leveraging an exogenous expansion to the Old Age Pension for men in South Africa, to approximate causal associations with cognitive function. We found evidence that there is a potential benefit of cash transfers at an earlier age for older individuals. As such, transfers such as pensions or other forms of direct basic income transfers may hold promise as potential interventions to promote healthy cognitive aging.
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Affiliation(s)
- Janet Jock
- O'Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, U.S.A
| | - Lindsay Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, U.S.A
| | - Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, U.S.A
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, U.S.A
| | - Coady Wing
- O'Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, U.S.A
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, U.S.A
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
| | - David Canning
- Harvard Center for Population and Development Studies, Cambridge, U.S.A
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Health and Population Research Center, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, U.S.A
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, Stephen Tollman, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Adkins-Jackson PB, Vázquez E, Henry-Ala FK, Ison JM, Cheney A, Akingbulu J, Starks C, Slay L, Dorsey A, Marmolejo C, Stafford A, Wen J, McCauley MH, Summers L, Bermudez L, Cruz-Roman ZL, Castillo I, Kipke MD, Brown AF. The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic. Health Promot Pract 2023; 24:232-243. [PMID: 36419256 PMCID: PMC9703012 DOI: 10.1177/15248399221132581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.
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Affiliation(s)
| | | | | | | | - Ann Cheney
- University of California, Riverside, Riverside, CA, USA
| | | | | | - Lindsay Slay
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander Dorsey
- Mending Minds Professional Clinical Counseling, Inc, Los Angeles, CA, USA
| | | | | | - James Wen
- St. John's Cathedral, Los Angeles, CA, USA
| | | | - Latrese Summers
- St. John's Well Child and Family Center, Inc., Los Angeles, CA, USA
| | | | | | | | | | - Arleen F Brown
- University of California, Los Angeles, Los Angeles, CA, USA
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Chakraborty R, Kobayashi LC, Jock J, Wing C, Chen X, Phillips M, Berkman L, Kahn K, Kabudula CW, Rosenberg M. Child Support Grant expansion and cognitive function among women in rural South Africa: findings from a natural experiment in HAALSI cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.18.23286130. [PMID: 36824712 PMCID: PMC9949209 DOI: 10.1101/2023.02.18.23286130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Cash transfers are a promising but understudied intervention that may protect cognitive function in adults by promoting their cognitive reserve. South Africa has a rapidly ageing population, however, less is known about the nature of association between cash transfers and cognitive function in this setting. We leveraged natural experiments from Child Support Grant (CSG) age-eligibility expansions to investigate the association between duration of CSG eligibility and cognitive function among biological mothers of child beneficiaries in South Africa. We analysed 2014/2015 baseline data from 944 women, aged 40 - 59 years with at least one CSG-eligible child, enrolled in the HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age eligibility expansion years. Cognitive function was measured using a cognitive battery administered to the mothers at baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers. Our study finds that high duration of CSG eligibility, compared to low, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high duration of CSG eligibility, compared to low, was associated with higher cognitive function z-scores [β: 0.19 SD; 95% CI: 0.05, 0.34, p-value = 0.02]. Government cash transfers given to support raising children may confer substantial protective effect on cognitive function of mothers in their mid-life. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Coady Wing
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Meredith Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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77
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Tang F, Li K, Rauktis ME, Buckley TD, Chi I. Immigration Experience and Cognitive Function Trajectories Among Older Chinese Immigrants. J Gerontol B Psychol Sci Soc Sci 2023; 78:124-135. [PMID: 35988160 PMCID: PMC9890920 DOI: 10.1093/geronb/gbac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Although a number of studies have documented cognitive health among older immigrants in the United States, little is known about how the life-course immigration experiences are associated with cognitive trajectories among older Chinese immigrants. We assess patterns of cognitive functioning and change over time and examine whether age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects are related to cognitive trajectories. METHODS The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011-2019). Latent class growth analysis and multinomial logistic regression were utilized. RESULTS Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, whereas speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognitive health such as age, education, and social engagement. DISCUSSION This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment and indicates that the risk of cognitive decline appears to be elevated with lower levels of acculturation and unidentified racial discrimination. More research is needed to fully understand the underlying mechanisms that link the life-course immigration experiences to cognitive health outcomes in later life.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ke Li
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary E Rauktis
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tommy D Buckley
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, Southern California, USA
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Quaye E, Galecki AT, Tilton N, Whitney R, Briceño EM, Elkind MSV, Fitzpatrick AL, Gottesman RF, Griswold M, Gross AL, Heckbert SR, Hughes TM, Longstreth WT, Sacco RL, Sidney S, Windham BG, Yaffe K, Levine DA. Association of Obesity With Cognitive Decline in Black and White Americans. Neurology 2023; 100:e220-e231. [PMID: 36257719 PMCID: PMC9841449 DOI: 10.1212/wnl.0000000000201367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are disparities in the prevalence of obesity by race, and the relationship between obesity and cognitive decline is unclear. The objective of this study was to determine whether obesity is independently associated with cognitive decline and whether the association between obesity and cognitive decline differs in Black and White adults. We hypothesized that obesity is associated with greater cognitive decline compared with normal weight and that the effect of obesity on cognitive decline is more pronounced in Black adults compared with their White counterparts. METHODS We pooled data from 28,867 participants free of stroke and dementia (mean, SD: age 61 [10.7] years at the first cognitive assessment, 55% female, 24% Black, and 29% obese) from 6 cohorts. The primary outcome was the annual change in global cognition. We performed linear mixed-effects models with and without time-varying cumulative mean systolic blood pressure (SBP) and fasting plasma glucose (FPG). Global cognition was set to a t-score metric (mean 50, SD 10) at a participant's first cognitive assessment; a 1-point difference represents a 0.1 SD difference in global cognition across the 6 cohorts. The median follow-up was 6.5 years (25th percentile, 75th percentile: 5.03, 20.15). RESULTS Obese participants had lower baseline global cognition than normal-weight participants (difference in intercepts, -0.36 [95% CI, -0.46 to -0.17]; p < 0.001). This difference in baseline global cognition was attenuated but was borderline significant after accounting for SBP and FPG (adjusted differences in intercepts, -0.19 [95% CI, -0.39 to 0.002]; p = 0.05). There was no difference in the rate of decline in global cognition between obese and normal-weight participants (difference in slope, 0.009 points/year [95% CI, -0.009 to 0.03]; p = 0.32). After accounting for SBP and FPG, obese participants had a slower decline in global cognition (adjusted difference in slope, 0.03 points/year slower [95% CI, 0.01 to 0.05]; p < 0.001). There was no evidence that race modified the association between body mass index and global cognitive decline (p = 0.34). DISCUSSION These results suggest that obesity is associated with lower initial cognitive scores and may potentially attenuate declines in cognition after accounting for BP and FPG.
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Affiliation(s)
- Emmanuel Quaye
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Andrzej T Galecki
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Nicholas Tilton
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Rachael Whitney
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Emily M Briceño
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Mitchell S V Elkind
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Annette L Fitzpatrick
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Rebecca F Gottesman
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Michael Griswold
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Alden L Gross
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Susan R Heckbert
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Timothy M Hughes
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - W T Longstreth
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Ralph L Sacco
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Stephen Sidney
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - B Gwen Windham
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Kristine Yaffe
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Deborah A Levine
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco.
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79
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Adkins-Jackson PB, Jackson Preston PA, Hairston T. 'The only way out': how self-care is conceptualized by Black women. ETHNICITY & HEALTH 2023; 28:29-45. [PMID: 35040742 DOI: 10.1080/13557858.2022.2027878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/06/2022] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Discrimination in the lives of Black women often leads to maladaptive coping strategies that negatively influence health. Self-care encompasses practices that promote well-being; however, little is known about how Black women conceptualize and practice self-care. DESIGN This article reports qualitative findings from 10 semi-structured interviews conducted with 10 Black women subject-matter experts (SMEs) from throughout the US. There were eight individual interviews with SMEs who provided self-care services/content to other Black women and two group interviews with SME organizations that provided self-care and other wellness programs to Black women. This approach utilized both expert and personal lived experiences of SMEs. RESULTS Using the constant comparison analysis method, there was saturation with four concepts that describe the role of structural racism and sexism on the health outcomes of Black women, and the potential for self-care to mediate the negative relationship of these stressors on health. SME practices of self-care overlapped, comprising a 5-part theory of self-care. CONCLUSION Ultimately, self-care may help to combat the impact of structural influences on the health of Black women. Using self-care as a healthier approach to coping with stress can aid in the reduction of health disparities.
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Affiliation(s)
| | | | - Teah Hairston
- Be Love Holistic and Safe Black Space, Sacramento, CA, USA
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80
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McDonough IM, Byrd DR, Choi SL. Resilience resources may buffer some middle-aged and older Black Americans from memory decline despite experiencing discrimination. Soc Sci Med 2023; 316:114998. [PMID: 35537879 DOI: 10.1016/j.socscimed.2022.114998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE Experiences of discrimination have been associated with poorer episodic memory in Black Americans. However, resilience resources at multiple levels (individual, social, and endowed) may act as a buffer to protect future memory decline, especially in the face of discrimination. OBJECTIVE Using longitudinal data from the 2006-2016 Health and Retirement Study (N = 1862), we tested whether Black Americans aged 50 and older would show different trajectories of episodic memory depending on their reported experiences of discrimination (everyday and major lifetime) and resilience resources. METHODS Analyses were conducted in three steps: (1) joint latent cluster mixed modeling (JLCMM) to estimate the number of classes, (2) barycentric discriminant analyses (BADA) to model the combined influence of discrimination and resilience resources between each memory class, and (3) multinomial regression analyses to explore interactions between discrimination and resilience resources. RESULTS JLCMM resulted in three memory classes that differentiated baseline from longitudinal memory performance: "High Decliners," "Low Decliners," and "Low Stable." Two independent patterns described the relationships between the three classes in the context of discrimination and resilience resources. First, compared with High Decliners, the two lower baseline memory classes (Low Decliners and Low Stable) reported more everyday discrimination and lower individual and endowed resilience resources. Second, although the Low Stable class did not report different levels of discrimination, they had more social resilience resources (greater social support and more social contact) than both declining classes. CONCLUSIONS Black Americans in later life have heterogeneous patterns of memory trajectories as demonstrated by the three memory classes identified. Those with lower baseline memory experienced more everyday discrimination and had fewer resilience resources compared to those with high baseline performance (High Decliners). Greater social resilience resources were associated with maintained episodic memory over time in Black Americans.
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Affiliation(s)
| | - DeAnnah R Byrd
- Edson College of Nursing and Health Innovation, Nursing and Health Innovation, Arizona State University, USA
| | - Shinae L Choi
- Department of Consumer Sciences, The University of Alabama, USA
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81
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Dobbins S, Hubbard E, Leutwyler H. Education Mediates Racial Disparities in Cognitive Impairment Among Older Adults With Schizophrenia. Clin Gerontol 2023; 46:66-79. [PMID: 33579181 PMCID: PMC8610378 DOI: 10.1080/07317115.2021.1882021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia. METHODS We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our "all-comer" sample (N = 64). The primary exposure is self-reported racial group. We examine mediation of cognitive impairment through educational attainment, adjusting for psychiatric illness severity, history of substance use, and vascular risk factors. RESULTS There was a Black/non-Black group racial disparity in global cognitive score (-2.8, 95% CI: -4.4, -1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education. CONCLUSIONS There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education. CLINICAL IMPLICATIONS Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia. ABBREVIATIONS CDE Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia.
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Affiliation(s)
- Sarah Dobbins
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Erin Hubbard
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Heather Leutwyler
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
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82
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Chen J, Spencer MRT, Buchongo P, Wang MQ. Hospital-based Health Information Technology Infrastructure: Evidence of Reduced Medicare Payments and Racial Disparities Among Patients With ADRD. Med Care 2023; 61:27-35. [PMID: 36349964 PMCID: PMC9741995 DOI: 10.1097/mlr.0000000000001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Alzheimer disease and related dementia (ADRD) is one of the most expensive health conditions in the United States. Understanding the potential cost-savings or cost-enhancements of Health Information Technology (HIT) can help policymakers understand the capacity of HIT investment to promote population health and health equity for patients with ADRD. OBJECTIVES This study examined access to hospital-based HIT infrastructure and its association with racial and ethnic disparities in Medicare payments for patients with ADRD. RESEARCH DESIGN We used the 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Association Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries who were diagnosed with ADRD. Our study focused on hospital-based telehealth-postdischarge (eg, remote patient monitoring) and telehealth-treatment (eg, psychiatric and addiction treatment) services. RESULTS Results showed that hospital-based telehealth postdischarge services were associated with significantly higher total Medicare payment and acute inpatient Medicare payment per person per year among patients with ADRD on average. The associations between hospital-based telehealth-treatment services and payments were not significant. However, the association varied by patient's race and ethnicity. The reductions of the payments associated with telehealth postdischarge and treatment services were more pronounced among Black patients with ADRD. Telehealth-treatment services were associated with significant payment reductions among Hispanic patients with ADRD. CONCLUSION Results showed that having hospital-based telehealth services might be cost-enhancing at the population level but cost-saving for Black and Hispanic patients with ADRD. Results suggested that personalized HIT services might be necessary to reduce the cost associated with ADRD treatment for racial and ethnic minority groups.
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Affiliation(s)
- Jie Chen
- Department of Health Policy and Management
- The Hospital And Public health interdisciPlinarY research (HAPPY) Lab
| | - Merianne Rose T. Spencer
- Department of Health Policy and Management
- The Hospital And Public health interdisciPlinarY research (HAPPY) Lab
| | - Portia Buchongo
- Department of Health Policy and Management
- The Hospital And Public health interdisciPlinarY research (HAPPY) Lab
| | - Min Qi Wang
- Department of Health Policy and Management
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD
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83
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Luth EA, Prigerson HG. Socioeconomic Status, Race/Ethnicity, and Unexpected Variation in Dementia Classification in Longitudinal Survey Data. J Gerontol B Psychol Sci Soc Sci 2022; 77:e234-e246. [PMID: 36048568 PMCID: PMC9799200 DOI: 10.1093/geronb/gbac128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES As dementia affects a growing number of older adults, it is important to understand its detection and progression. We identified patterns in dementia classification over time using a longitudinal, nationally representative sample of older adults. We examined the relationship between socioeconomic status and race/ethnicity, and patterns in dementia classification. METHODS Data for 7,218 Medicare beneficiaries from the 2011-2017 National Health and Aging Trends Study (NHATS) were classified into five categories: consistently no dementia, consistently cognitive impairment, "typical" dementia progression, "expected" variation, and "unexpected" variation. Multivariable multinomial logistic regression assessed relative risk of dementia classification by sociodemographic and health factors. RESULTS Among NHATS respondents, 59.5% consistently were recorded as having no dementia, 7% consistently cognitively impaired, 13% as having typical progression, 15% as having expected variation, and 5.5% as having unexpected variation. In multivariable models, compared with consistent dementia classification, less education, Medicare-Medicaid-dual enrollment, and identifying as non-Hispanic Black were associated with increased likelihood of unexpected variation (e.g., non-Hispanic Black adjusted risk ratio: 2.12, 95% CI: 1.61-2.78, p < .0001). DISCUSSION A significant minority of individuals have unexpected patterns of dementia classification over time, particularly individuals with low socioeconomic status and identifying as non-Hispanic Black. Dementia classification uncertainty may make it challenging to activate resources (e.g., health care, caregiving) for effective disease management, underscoring the need to support persons from at-risk groups and to carefully evaluate cognitive assessment tools to ensure they are equally reliable across groups to avoid magnifying disparities.
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Affiliation(s)
- Elizabeth A Luth
- Institute for Health, Healthcare Policy and Aging Research, Department of Family Medicine and Community Health, Rutgers University, New Brunswick, New Jersy, USA
| | - Holly G Prigerson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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84
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Roberg BL, Anzalone C, Nicholson JD, Peruggia PE, Buckley TR. Performance Comparisons on the Saint Louis University Mental Status Examination Between Black and White Veterans and Education Classification in a Large Outpatient Sample from the Southern United States. Arch Clin Neuropsychol 2022; 38:633-643. [DOI: 10.1093/arclin/acac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 12/07/2022] Open
Abstract
Abstract
Objective
An increasing scientific literature recognizes that traditional cut-off scores for cognitive screeners may not be optimal for use in patients who differ in race/ethnicity from the screeners’ normative/reference group. There is also literature on how racial/ethnic contextual factors, such as stereotype threat or perceived discrimination, may influence performance on cognitive testing. The current study examined the characteristics of SLUMS (a cognitive screening measure) performance in a large (n = 602) sample of Black (n = 229) and White (n = 373) veterans in a VA hospital located in the Southern United States.
Method
SLUMS data were gathered from retrospective electronic chart review between January 2013 and February 2020. Race/ethnicity of veterans was gathered by chart review and race of hospital providers who administered the SLUMS by personal communication.
Results
Black veterans were 1.99 times more likely to be classified by total SLUMS score as being within the dementia range compared with White veterans. Differences in item level performance were only found between Black and White veterans with ≥ high school education. Race of clinical provider (i.e., Black or White) administering the SLUMS did not significantly impact veteran performance on the SLUMS.
Conclusion
This is the first large sample study of differences in SLUMS performance between Black and White veterans. Findings replicate earlier research on Black and White performance differences on individual SLUMS items and provide an analysis of examiner–examinee racial discordance. This study underscores the importance of researching cognitive measures in groups who differ from the original normative/references samples.
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Affiliation(s)
- Brandon L Roberg
- Columbia VA Health Care System , Mental Health Service Line, Columbia, SC , USA
- The University of South Carolina , Department of Psychology, Columbia, SC , USA
| | | | - Jessica D Nicholson
- VA Memphis Health Care System , Mental Health Service Line, Memphis, TN , USA
| | - Patricia E Peruggia
- Columbia VA Health Care System , Mental Health Service Line, Columbia, SC , USA
| | - Trevor R Buckley
- Columbia VA Health Care System , Mental Health Service Line, Columbia, SC , USA
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Casten R, Leiby BE, Kelley M, Rovner BW. A randomized controlled trial to test the efficacy of a diabetes behavioral intervention to prevent memory decline in older blacks/African Americans with diabetes and mild cognitive impairment. Contemp Clin Trials 2022; 123:106977. [PMID: 36341847 PMCID: PMC9787831 DOI: 10.1016/j.cct.2022.106977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The prevalence of dementia in Blacks/African Americans (AAs) is almost twice that of Whites. Inequities in access to health care, socioeconomic conditions, and diabetes contribute to this disparity. Poorly controlled diabetes, which is more prevalent in Blacks/AAs, causes microvascular disease and neurodegeneration and increases dementia risk. Improving glycemic control, therefore, may prevent cognitive decline. To address this issue, we developed Diabetes Regulation for Eyesight and Memory (DREAM), a community health worker (CHW)-led behavioral intervention to improve diabetes self-management and thereby prevent cognitive decline. DREAM consists of home-based diabetes education, goal setting, and telehealth visits with a diabetes nurse educator. Exploratory aims will investigate whether APOE genotype moderates and retinal biomarkers mediate treatment effects. This report describes the trial's rationale, methodology, and study procedures. (clinicaltrials.gov identifier NCT04259047). METHODS This randomized controlled trial will test the efficacy of DREAM to prevent decline in memory (primary outcome) in Blacks/AAs aged 65+ with poorly controlled diabetes and Mild Cognitive Impairment (MCI). Two hundred participants will be randomized to DREAM or an attention control condition, and will receive 11 in-home treatment sessions over two years. Outcome data are collected at 6, 12, 18, and 24 months. The primary outcome is verbal learning as measured by Hopkins Verbal Learning Test (HVLT) Total Recall scores. Participants will have retinal imaging at baseline, 12, and 24 months. CONCLUSIONS This research aims to prevent cognitive decline in older Blacks/AAs with diabetes and MCI. If successful, this research will preserve health in an underserved population and reduce racial health disparities.
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Affiliation(s)
- Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas, Jefferson University, 1015 Walnut Street, Suite 709, Philadelphia, PA 19107, USA.
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Sidney, Kimmel Medical College at Thomas Jefferson University, 130 S. 19(th) St, 17(th) Floor, Philadelphia, PA 19107, USA.
| | - Megan Kelley
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015, Walnut Street, Suite 709, Philadelphia, PA 19107, USA.
| | - Barry W Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA.
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86
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Beydoun MA, Weiss J, Banerjee S, Beydoun HA, Noren Hooten N, Evans MK, Zonderman AB. Race, polygenic risk and their association with incident dementia among older US adults. Brain Commun 2022; 4:fcac317. [PMID: 36569604 PMCID: PMC9772879 DOI: 10.1093/braincomms/fcac317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/26/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Dementia incidence increases steadily with age at rates that may vary across racial groups. This racial disparity may be attributable to polygenic risk, as well as lifestyle and behavioural factors. We examined whether Alzheimer's disease polygenic score and race predict Alzheimer's disease and other related dementia incidence differentially by sex and mediation through polygenic scores for other health and behavioural conditions. We used longitudinal data from the nationally representative Health and Retirement Study. We restricted participants to those with complete data on 31 polygenic scores, including Alzheimer's disease polygenic score (2006-2012). Among participants aged 55 years and older in 2008, we excluded those with any memory problems between 2006 and 2008 and included those with complete follow-up on incident Alzheimer's disease and all-cause dementia, between 2010 and 2018 (N = 9683), based on self- or proxy-diagnosis every 2 years (2010, 2012, 2014, 2016 and 2018). Cox proportional hazards and 4-way decomposition models were conducted. Analyses were also stratified by sex and by race. There were racial differences in all-cause dementia incidence (age and sex-adjusted model, per standard deviation: hazard ratio, HR = 1.34, 95% confidence interval, CI: 1.09-1.65, P = 0.007), partially driven by educational attainment and income. We also found independent associations of race (age and sex-adjusted model, African American versus White adults: HR = 2.07, 95% CI: 1.52-2.83, P < 0.001) and Alzheimer's disease polygenic score (age and sex-adjusted model, per SD: HR = 1.37, 95% CI: 1.00-1.87, P < 0.001) with Alzheimer's disease incidence, including sex differences whereby women had a stronger effect of Alzheimer's disease polygenic score on Alzheimer's disease incidence compared with men (P < 0.05 for sex by Alzheimer's disease polygenic score interaction) adjusting for race and other covariates. The total impact of Alzheimer's disease polygenic scores on Alzheimer's disease incidence was mostly direct, while the effect of race on all-cause dementia incidence was mediated through socio-economic, lifestyle and health-related factors. Finally, among the 30 polygenic scores we examined, the total effects on the pathway Alzheimer's disease polygenic score --> Other polygenic score --> Incident Alzheimer's or all-cause dementia, were statistically significant for all, driven primarily by the controlled direct effect (P< 0. 001). In conclusion, both race and Alzheimer's disease polygenic scores were associated independently with Alzheimer's disease and all-cause dementia incidence. Alzheimer's disease polygenic score was more strongly linked to incident Alzheimer's disease among women, while racial difference in all-cause dementia was explained by other factors including socio-economic status.
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Affiliation(s)
- May A Beydoun
- Correspondence to: May A. Beydoun, PhD NIH Biomedical Research Center National Institute on Aging, IRP 251 Bayview Blvd. Suite 100, Room #: 04B118, Baltimore, MD 21224, USA E-mail:
| | | | - Sri Banerjee
- College of Health Professions, School of Health Sciences, Walden University, Baltimore, MD 21202, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD 21224, USA
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Staben OE, Infurna FJ, Lachman ME, Gerstorf D. Examining Racial Disparities in Historical Change of Mental and Physical Health Across Midlife and Old Age in the United States. J Gerontol B Psychol Sci Soc Sci 2022; 77:1978-1989. [PMID: 34928351 PMCID: PMC9683502 DOI: 10.1093/geronb/gbab232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time. METHODS Multilevel models were applied to longitudinal data on middle-aged (ages 40-65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health. RESULTS Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes. DISCUSSION Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time.
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Affiliation(s)
- Omar E Staben
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Frank J Infurna
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts, USA
| | - Denis Gerstorf
- Department of Psychology, Humboldt University, Berlin, Germany
- Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, USA
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88
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Shaked D, Katzel LI, Davatzikos C, Gullapalli RP, Seliger SL, Erus G, Evans MK, Zonderman AB, Waldstein SR. White matter integrity as a mediator between socioeconomic status and executive function. Front Hum Neurosci 2022; 16:1021857. [PMID: 36466616 PMCID: PMC9716285 DOI: 10.3389/fnhum.2022.1021857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/04/2022] [Indexed: 11/03/2023] Open
Abstract
Introduction Lower socioeconomic status (SES) is associated with poorer executive function, but the neural mechanisms of this association remain unclear. As healthy brain communication is essential to our cognitive abilities, white matter integrity may be key to understanding socioeconomic disparities. Methods Participants were 201 African American and White adults (ages 33-72) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study. Diffusion tensor imaging was used to estimate regional fractional anisotropy as a measure of white matter integrity. Adjusting for age, analyses examined if integrity of the anterior limb of the internal capsule (ALIC), external capsule (EC), superior longitudinal fasciculus (SLF), and cingulum mediated SES-executive function relations. Results Lower SES was related to poorer cognitive performance and white matter integrity. Lower Trails B performance was related to poorer integrity of the ALIC, EC, and SLF, and lower Stroop performance was associated with poorer integrity of the ALIC and EC. ALIC mediated the SES-Trails B relation, and EC mediated the SES-Trails B and SES-Stroop relations. Sensitivity analyses revealed that (1) adjustment for race rendered the EC mediations non-significant, (2) when using poverty status and continuous education as predictors, results were largely the same, (3) at least some of the study's findings may generalize to processing speed, (4) mediations are not age-dependent in our sample, and (5) more research is needed to understand the role of cardiovascular risk factors in these models. Discussion Findings demonstrate that poorer white matter integrity helps explain SES disparities in executive function and highlight the need for further clarification of the biopsychosocial mechanisms of the SES-cognition association.
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Affiliation(s)
- Danielle Shaked
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, United States
- Department of Psychology, VA Boston Health Care System, Boston, MA, United States
| | - Leslie I. Katzel
- Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, United States
| | - Christos Davatzikos
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rao P. Gullapalli
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Stephen L. Seliger
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, United States
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Guray Erus
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, United States
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, United States
| | - Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
- Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, United States
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89
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Babulal GM, Rani R, Adkins-Jackson P, Pearson AC, Williams MM. Associations between Homelessness and Alzheimer's Disease and Related Dementia: A Systematic Review. J Appl Gerontol 2022; 41:2404-2413. [PMID: 35750476 PMCID: PMC10018777 DOI: 10.1177/07334648221109747] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The homeless population in the United States is rapidly aging, with a parallel increase in Alzheimer's disease and related dementia (ADRD). During an evolving pandemic that jeopardizes employment and housing, assessing the relationship between ADRD and homelessness is critical since the latter is potentially intervenable. The objective of this study is to review the literature and determine whether there is an association between homelessness and dementia risk. A systematic review of existing studies was conducted through PubMED, SCOPUS, and EMBASE among others. Of the 228 results found, nine met inclusion criteria. Homeless studies mainly centered on veteran populations (n = 6/9). There is a complex relationship suggesting homelessness as a risk for and consequence of ADRD but also co-occurrence with psychiatric disorders, substance abuse, and traumatic injuries. Future studies should employ enumeration surveys with modular longitudinal tracking and measure social determinants of health, discrimination, chronic stress, and mood disorders.
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Affiliation(s)
- Ganesh M. Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rohan Rani
- Department of Molecular and Cellular Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Adam C. Pearson
- Peter & Paul Community Services, St. Louis, MO, USA
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Monique M. Williams
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
- New Horizons PACE, St. Louis, MO, USA
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90
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Salomon RE, Dobbins S, Harris C, Haeusslein L, Lin CX, Reeves K, Richoux S, Roussett G, Shin J, Dawson-Rose C. Antiracist symptom science: A call to action and path forward. Nurs Outlook 2022; 70:794-806. [PMID: 36400578 PMCID: PMC10916506 DOI: 10.1016/j.outlook.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Nurse scientists recognize the experience of racism as a driving force behind health. However, symptom science, a pillar of nursing, has rarely considered contributions of racism. Our objective is to describe findings within symptom science research related to racial disparities and/or experiences of racism and to promote antiracist symptom science within nursing research. In this manuscript, we use an antiracist lens to review a predominant symptom science theory and literature in three areas of symptom science research-oncology, mental health, and perinatal health. Finally, we make recommendations for increasing antiracist research in symptom science by altering (a) research questions, (b) recruitment methods, (c) study design, (d) data analysis, and (e) dissemination of findings. Traditionally, symptom science focuses on individual level factors rather than broader contexts driving symptom experience and management. We urge symptom science researchers to embrace antiracism by designing research with the specific intent of dismantling racism at multiple levels.
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Affiliation(s)
- Rebecca E Salomon
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah Dobbins
- San Francisco Department of Public Health, San Francisco, California
| | | | | | - Chen-Xi Lin
- University of California, San Francisco, San Francisco, California
| | - Katie Reeves
- University of California, San Francisco, San Francisco, California
| | - Sarah Richoux
- University of California, San Francisco, San Francisco, California
| | - Greg Roussett
- University of California, San Francisco, San Francisco, California
| | - Joosun Shin
- University of California, San Francisco, San Francisco, California
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91
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Wang Y, Wong R, Amano T, Shen H. Associations between volunteering and cognitive impairment: The moderating role of race/ethnicity. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4433-e4441. [PMID: 35599382 PMCID: PMC10084262 DOI: 10.1111/hsc.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/15/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Although volunteering has been shown to benefit cognitive health, there is a paucity of evidence on informal volunteering and subjective measures of cognitive impairment. Also, little is known about whether such relationships vary by race/ethnicity. This study aimed to examine the associations of both formal and informal volunteering with older adults' objective and subjective cognition and explore the moderating role of race/ethnicity in such associations. Using data from the Health and Retirement Study in the United States (2010-2016), 9941 older adults (51+) who were cognitively unimpaired in 2010 and alive through 2016 were included. Ordered logistic regression models were performed to assess the relationships among volunteering, cognitive impairment and race/ethnicity. Findings showed that more years of formal and informal volunteering significantly reduced the odds of objective cognitive impairment; neither volunteering type was significant for subjective cognitive impairment. The relationship between informal volunteering and objective cognition varied by race/ethnicity. Compared to non-Hispanic Whites, non-Hispanic Black older adults who engaged in more years of informal volunteering had a significantly higher odds of cognitive impairment over time. The current study is one of the first to look at the associations between informal volunteering and cognition. The inclusion of subjective cognitive impairment, paired with objective measures of cognition, also adds value to the knowledge body. Our findings indicate any type of volunteering is a viable approach to prevent cognitive impairment for older populations. However, more research is needed to better understand why racial/ethnic minority, particularly non-Hispanic Black older adults, do not benefit from informal volunteering.
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Affiliation(s)
- Yi Wang
- School of Social WorkUniversity of IowaIowa CityIowaUSA
| | - Roger Wong
- Department of Public Health and Preventive MedicineState University of New York Upstate Medical UniversitySyracuseNew YorkUSA
| | - Takashi Amano
- Department of Social WorkRutgers University – NewarkNewarkNew JerseyUSA
| | - Huei‐Wern Shen
- Department of Social WorkUniversity of North TexasDentonTexasUSA
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92
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Liu C, Murchland AR, VanderWeele TJ, Blacker D. Eliminating racial disparities in dementia risk by equalizing education quality: A sensitivity analysis. Soc Sci Med 2022; 312:115347. [PMID: 36162365 PMCID: PMC9990698 DOI: 10.1016/j.socscimed.2022.115347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/06/2022] [Accepted: 09/01/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Higher risk of dementia among racial/ethnic minorities compared to White populations in the U.S. has been attributed to life-course exposures to adverse conditions such as lower educational attainment, but most studies have not considered additional disparities in education quality. We sought to determine the extent to which disparities in dementia would be reduced had different racial groups received the same quality of education, with no change to present disparities in educational attainment. METHODS We conducted a literature review to assess whether and how measures of educational attainment and quality are utilized in the development of norms for standard cognitive screening measures. In a separate search of the literature, we identified estimates of relationships between race, education quality and dementia; and calculated the adjusted association between race and dementia had education quality been equalized between Black and White participants. RESULTS Most norms for cognitive measures included educational attainment, but few addressed quality. Our search identified relevant parameter estimates: 44.3% of Black participants and 10.5% of White participants had "limited literacy" (<9th grade reading level, a potential marker of poor education quality), which was associated with a 53% greater hazard of dementia compared with "adequate literacy" (≥ 9th grade reading level) after adjusting for educational attainment. Applying these parameters to a hazard ratio of 1.37 (95%CI: 1.12,1.67) for the risk of dementia comparing Black to White participants, we obtained an adjusted hazard ratio of 1.17 (0.96,1.43), a 54% reduction. DISCUSSION Present studies are limited in their consideration of education quality. Our work using available measures from the literature suggests that if education quality were equalized across groups by race, without changing disparities in attainment, racial disparities in dementia would be reduced by about half. Future work should seek to consistently incorporate education quality in order to better understand the sources of disparities.
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Affiliation(s)
- Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Audrey R Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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93
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Kobayashi LC, Kabudula CW, Kabeto MU, Yu X, Tollman SM, Kahn K, Berkman LF, Rosenberg MS. Long-term household material socioeconomic resources and cognitive health in a population-based cohort of older adults in rural northeast South Africa, 2001-2015. SSM Popul Health 2022; 20:101263. [PMID: 36281246 PMCID: PMC9587313 DOI: 10.1016/j.ssmph.2022.101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Material resources owned by households that affect daily living conditions may be salient for cognitive health during aging, especially in low-income settings, but there is scarce evidence on this topic. We investigated relationships between long-term trends in household material resources and cognitive function among older adults in a population-representative study in rural South Africa. Data were from baseline interviews with 4580 adults aged ≥40 in “Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) in 2014/2015 linked to retrospective records on their household material resources from the Agincourt Health and Socio-Demographic Surveillance System (HDSS) from 2001 to 2013. Household material resources were assessed biennially in the Agincourt HDSS using a five-point index that captured dwelling materials, water and sanitation, sources of power, livestock, and technological amenities. Cognitive function was assessed in HAALSI and analyzed as a z-standardized latent variable capturing time orientation, episodic memory, and numeracy. We evaluated the relationships between quintiles of each of the mean resource index score, volatility in resource index score, and change in resource index score and subsequent cognitive function, overall and by resource type. Higher mean household resources were positively associated with cognitive function (βadj = 0.237 standard deviation [SD] units for the highest vs. lowest quintile of mean resource index score; 95% CI: 0.163–0.312; p-trend<0.0001), as were larger improvements over time in household resources (βadj = 0.122 SD units for the highest vs. lowest quintile of change in resources; 95% CI: 0.040–0.205; p-trend = 0.001). Results were robust to sensitivity analyses assessing heterogeneity by age and restricting to those with formal education. The findings were largely driven by technological amenities including refrigerators, stoves, telephones, televisions, and vehicles. These amenities may support cognitive function through improving nutrition and providing opportunities for cognitive stimulation through transportation and social contact outside of the home. Data were from a population-based longitudinal study of aging in rural South Africa. We found that household material resources may support cognitive health during aging. Greater improvements in resources over time were associated with better cognition. Results were driven by resources for cooking, transportation, and communication. Future research should study how household resources may promote cognitive health.
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Affiliation(s)
- Lindsay C. Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Corresponding author. Dr Lindsay Kobayashi, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48103, United States.
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed U. Kabeto
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Xuexin Yu
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Stephen M. Tollman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH), Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH), Accra, Ghana
| | - Lisa F. Berkman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States
| | - Molly S. Rosenberg
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
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94
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The association of residential racial segregation with health among U.S. children: A nationwide longitudinal study. SSM Popul Health 2022; 19:101250. [PMID: 36238814 PMCID: PMC9550534 DOI: 10.1016/j.ssmph.2022.101250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Residential racial segregation in the U.S. has been hypothesized as a fundamental cause driving health disparities across racial groups. Potential mechanisms include economic and social marginalization, subsequent constrained opportunities, and high stress. Yet evidence on residential segregation's association with health among Black and White children—particularly longitudinally—is sparse. This study aims to address this gap. We used data from the Panel Study of Income Dynamics (PSID), a national longitudinal study of U.S. households, analyzing information on 1,251 Black and 1,427 White children who participated in the Child Development Supplement (CDS) at least twice (survey waves 1997, 2002, 2007, 2014). We fit individual fixed-effects models to estimate the within-person association of neighborhood-level residential segregation, measured with local Getis-Ord G* statistics, with three outcomes (general health, weight status, and behavioral problems). We examined heterogeneous effects by age and sex. We also examined associations between health and childhood segregation trajectories, i.e., the pattern of children's residential segregation exposures from birth through when their health outcomes were measured, providing additional insight on dynamic experiences of segregation. In fixed effects models, among Black children, higher segregation was associated with worse self-rated health, especially for Black children who were older (aged 11–17 years). In trajectory models, among White children, moving out of highly segregated neighborhoods was associated with a lower probability of poor self-rated health, while moving into those neighborhoods or back and forth between neighborhood types were both associated with increased behavioral problems. Our findings highlight the importance of early-life residential segregation in shaping persistent racial health disparities, as well as the costs of segregation for all children living in highly segregated neighborhoods. We used a national longitudinal data set with rich health and residential history data observed throughout childhood. We employed fixed effects models and trajectory models. Living in segregated neighborhoods was associated with poorer self-rated health among Black and White children. Moving into segregated neighborhoods was associated with more behavioral problems among White children. Interventions are needed to reduce segregation and improve health-promoting resources for children in segregated communities.
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95
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Muñoz E, Robins RW, Sutin AR. Perceived ethnic discrimination and cognitive function: A 12-year longitudinal study of Mexican-origin adults. Soc Sci Med 2022; 311:115296. [PMID: 36088721 DOI: 10.1016/j.socscimed.2022.115296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/12/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hispanic/Latinx adults are at increased risk for cognitive impairment, and it is critically important to identify modifiable risk factors for cognitive impairment in this population. We addressed two key questions: (1) How does perceived discrimination change across middle adulthood? And, (2) how are discrimination and the trajectory of discrimination associated with cognitive function? METHODS We used data from 1,110 Mexican-origin adults between 26 and 62 years old (63% female; 85% born in Mexico). Participants completed a perceived ethnic discrimination scale five times across 12 years and completed cognitive assessments in the last wave, which were composited into a measure of overall cognitive function. We used latent growth curve models to estimate the longitudinal trajectory of perceived ethnic discrimination and growth mixture models to identify sub-groups of change trajectories. We evaluated whether patterns of perceived discrimination trajectories, baseline, intermediary, and concurrent discrimination predicted cognitive function at the last wave. RESULTS Perceived ethnic discrimination decreased over time on average. Significant individual differences in within-person change revealed two change trajectory classes: Stable Low and High Declining. The Stable Low class had better cognitive performance compared to the High Declining class, but this effect was not robust to educational attainment. Perceived discrimination at the last wave was associated with worse cognitive function, and this effect remained after accounting for covariates. CONCLUSIONS This study is among the first to evaluate changes in perceived ethnic discrimination in a sample of Mexican-origin adults and their associations with cognitive function. The results highlight the need for more research to better understand the role of discrimination and other social stressors on cognitive health outcomes.
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Affiliation(s)
- Elizabeth Muñoz
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA.
| | - Richard W Robins
- Department of Psychology, University of California, Davis, CA, USA
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
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96
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[Revue systématique des tests cognitifs validés et/ou ayant des normes de référence pour la population canadienne francophone âgée]. Can J Aging 2022; 42:297-315. [PMID: 36120908 DOI: 10.1017/s0714980822000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Il est essentiel d'utiliser des tests cognitifs ayant été validés et détenant des normes de référence auprès de la population cible, puisque les réalités culturelles et linguistiques différentes entre l'échantillon de validation ou auprès duquel les normes ont été créées et la population cible peuvent affecter les résultats. Cette revue systématique vise à recenser et décrire les tests cognitifs (incluant tests, questionnaires et grilles d'observation) validés et/ou présentant des normes sur la population âgée canadienne francophone. Au total, 46 articles ont été sélectionnés. Cette revue recense 9 tests validés, 20 tests avec normes de référence et 18 tests validés et avec normes, couvrant la majorité des domaines cognitifs (fonctions mnésiques, attentionnelles, exécutives, perceptivo-motrices et langagières), excepté la cognition sociale. La quasi-totalité des échantillons ont été recrutés au Québec. Les tests relevés présentent majoritairement des indices psychométriques satisfaisants et généralement des normes considérant l'âge, le sexe et l'éducation. Cette revue systématique permettra aux cliniciens et chercheurs canadiens en vieillissement d'orienter optimalement leurs choix de tests cognitifs.
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97
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Adkins-Jackson PB, Belsky DW. Alzheimer's disease risk biomarkers: progress and challenges. THE LANCET. HEALTHY LONGEVITY 2022; 3:e575-e576. [PMID: 36102768 DOI: 10.1016/s2666-7568(22)00191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Paris B Adkins-Jackson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
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98
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Kamalyan L, Guareña LA, Díaz-Santos M, Suarez P, Cherner M, García Alcorn MY, Umlauf A, Franklin DR, Mindt MR, Fortuny LAI, Heaton RK, Marquine MJ. Influence of Educational Background, Childhood Socioeconomic Environment, and Language Use on Cognition among Spanish-Speaking Latinos Living Near the US-Mexico Border. J Int Neuropsychol Soc 2022; 28:876-890. [PMID: 34486514 PMCID: PMC8898321 DOI: 10.1017/s1355617721001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We investigated the impact of culturally relevant social, educational, and language factors on cognitive test performance among Spanish speakers living near the US-Mexico border. METHODS Participants included 254 healthy native Spanish speakers from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project (Age: M = 37.3, SD = 10.4; Education: M = 10.7, SD = 4.3; 59% Female). A comprehensive neuropsychological battery was administered in Spanish. Individual test scaled scores and T-scores (based on region-specific norms adjusted for age, education, and sex) were averaged to create Global Mean Scaled and T-scores. Measures of culturally relevant factors included a self-reported indicator of educational quality/access (proportion of education in Spanish-speaking country, quality of school/classroom setting, stopped attending school to work), childhood socioeconomic environment (parental education, proportion of time living in Spanish-speaking country, childhood socioeconomic and health status, access to basic resources, work as a child), and Spanish/English language use and fluency. RESULTS Several culturally relevant variables were significantly associated with unadjusted Global Scaled Scores in univariable analyses. When using demographically adjusted T-scores, fewer culturally relevant characteristics were significant. In multivariable analyses, being bilingual (p = .04) and working as a child for one's own benefit compared to not working as a child (p = .006) were significantly associated with higher Global Mean T-score, accounting for 9% of variance. CONCLUSIONS Demographically adjusted normative data provide a useful tool for the identification of brain dysfunction, as these account for much of the variance of sociocultural factors on cognitive test performance. Yet, certain culturally relevant variables still contributed to cognitive test performance above and beyond basic demographics, warranting further investigation.
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Affiliation(s)
- Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Lesley A. Guareña
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- Department of Medicine, Division of Geriatrics and Gerontology, University of California, San Diego
| | - Mirella Díaz-Santos
- Department of Psychiatry and Biobehavioral Sciences, Hispanic Neuropsychiatric Center of Excellence, University of California, Los Angeles
| | - Paola Suarez
- Department of Psychiatry and Biobehavioral Sciences, Hispanic Neuropsychiatric Center of Excellence, University of California, Los Angeles
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | | | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Donald R. Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Monica Rivera Mindt
- Department of Psychology & Latino American and Latino Studies Institute, Fordham University
| | | | - Robert K. Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - María J. Marquine
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- Department of Medicine, Division of Geriatrics and Gerontology, University of California, San Diego
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Brown MT, Mutambudzi M. Psychiatric history and later-life cognitive change: effect modification by sex, race and ethnicity. Aging Ment Health 2022:1-8. [PMID: 36016466 DOI: 10.1080/13607863.2022.2116398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: We explored associations between psychiatric history and cognitive functioning, and differences by sex and race/ethnicity (SRE) in 20,155 Health and Retirement Study (1995-2014) participants aged 65 or older.Methods: Multi-level growth curve models examined cognition scores and their trajectories over time by SRE.Results: A history of psychiatric, emotional, or nervous problems was significantly related to cognition scores and rates of decline. Hispanic and Black participants had significantly lower cognition scores at age 75 and steeper rates of decline than White females, and Black race and the Hispanic race/ethnicity-sex interaction erased the protective effects of being female.Conclusions: Future research should include specific psychiatric diagnoses. Population level findings as reported here, along with aggregate findings from similar studies, can inform interventions and policies regarding support for populations that are vulnerable to mental illness and to subsequent cognitive decline.
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Affiliation(s)
- Maria T Brown
- School of Social Work and Aging Studies Institute, Syracuse University, Syracuse, NY, USA
| | - Miriam Mutambudzi
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, USA
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100
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Snead R, Dumenci L, Jones RM. A latent class analysis of cognitive decline in US adults, BRFSS 2015-2020. BMC Public Health 2022; 22:1560. [PMID: 35974367 PMCID: PMC9380313 DOI: 10.1186/s12889-022-14001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive decline can be an early indicator for dementia. Using quantitative methods and national representative survey data, we can monitor the potential burden of disease at the population-level. METHODS BRFSS is an annual, nationally representative questionnaire in the United States. The optional cognitive decline module is a six-item self-reported scale pertaining to challenges in daily life due to memory loss and growing confusion over the past twelve months. Respondents are 45+, pooled from 2015-2020. Latent class analysis was used to determine unobserved subgroups of subjective cognitive decline (SCD) based on item response patterns. Multinomial logistic regression predicted latent class membership from socio-demographic covariates. RESULTS A total of 54,771 reported experiencing SCD. The optimal number of latent classes was three, labeled as Mild, Moderate, and Severe SCD. Thirty-five percent of the sample belonged to the Severe group. Members of this subgroup were significantly less likely to be older (65+ vs. 45-54 OR = 0.29, 95% CI: 0.23-0.35) and more likely to be non-Hispanic Black (OR = 1.80, 95% CI: 1.53-2.11), have not graduated high school (OR = 1.60, 95% CI: 1.34-1.91), or earned <$15K a year (OR = 3.03, 95% CI: 2.43-3.77). CONCLUSIONS This study determined three latent subgroups indicating severity of SCD and identified socio-demographic predictors. Using a single categorical indicator of SCD severity instead of six separate items improves the versatility of population-level surveillance.
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Affiliation(s)
- Ryan Snead
- Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA.
| | - Levent Dumenci
- Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA.,Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Resa M Jones
- Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA.,Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
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