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Garuma D, Lamba D, Abessa TG, Bonnechère B. Advancing public health: enabling culture-fair and education-independent automated cognitive assessment in low- and middle-income countries. Front Public Health 2024; 12:1377482. [PMID: 39005983 PMCID: PMC11239414 DOI: 10.3389/fpubh.2024.1377482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Desalegm Garuma
- Department of Psychology, College of Education and Behavorial Sciences, Jimma University, Jimma, Ethiopia
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dheeraj Lamba
- Department of Physiotherapy, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teklu Gemechu Abessa
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
- Centre of Expertise in Care Innovation, Department of PXL–Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
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Jimenez MP, Gause EL, Sims KD, Hayes‐Larson E, Morris EP, Fletcher E, Manly J, Gilsanz P, Soh Y, Corrada M, Whitmer RA, Glymour MM. Racial and ethnic differences in the association between depressive symptoms and cognitive outcomes in older adults: Findings from KHANDLE and STAR. Alzheimers Dement 2024; 20:3147-3156. [PMID: 38477489 PMCID: PMC11095484 DOI: 10.1002/alz.13768] [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: 10/18/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Depressive symptoms are associated with higher risk of dementia, but how they impact cognition in diverse populations is unclear. METHODS Asian, Black, Latino, or White participants (n = 2227) in the Kaiser Healthy Aging and Diverse Life Experiences (age 65+) and the Study of Healthy Aging in African Americans (age 50+) underwent up to three waves of cognitive assessments over 4 years. Multilevel models stratified by race/ethnicity were used to examine whether depressive symptoms were associated with cognition or cognitive decline and whether associations differed by race/ethnicity. RESULTS Higher depressive symptoms were associated with lower baseline verbal episodic memory scores (-0.06, 95% CI: -0.12, -0.01; -0.15, 95% CI: -0.25, -0.04), and faster decline annually in semantic memory (-0.04, 95% CI: -0.07, -0.01; -0.10, 95% CI: -0.15, -0.05) for Black and Latino participants. Depressive symptoms were associated with lower baseline but not decline in executive function. DISCUSSION Depressive symptoms were associated with worse cognitive outcomes, with some evidence of heterogeneity across racial/ethnic groups. HIGHLIGHTS We examined whether baseline depressive symptoms were differentially associated with domain-specific cognition or cognitive decline by race/ethnicity. Depressive symptoms were associated with worse cognitive scores for all racial/ethnic groups across different domains examined. Higher depressive symptoms were associated with faster cognitive decline for semantic memory for Black and Latino participants. The results suggest a particularly harmful association between depressive symptoms and cognition in certain racial/ethnic groups.
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Affiliation(s)
- Marcia P. Jimenez
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Emma L. Gause
- Center for Climate and HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Kendra D. Sims
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Eleanor Hayes‐Larson
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Emily P. Morris
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Evan Fletcher
- Department of NeurologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Jennifer Manly
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - Paola Gilsanz
- Division of ResearchKaiser PermanenteOaklandCaliforniaUSA
| | - Yenee Soh
- Division of ResearchKaiser PermanenteOaklandCaliforniaUSA
| | - Maria Corrada
- Department of EpidemiologyUniversity of California Irvine School of MedicineIrvineCaliforniaUSA
| | - Rachel A. Whitmer
- Department of Public Health Sciences and NeurologyUniversity of California Davis School of MedicineDavisCaliforniaUSA
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Jimenez MP, Gause EL, Hayes-Larson E, Morris EP, Fletcher E, Manly J, Gilsanz P, Soh Y, Corrada M, Whitmer RA, Glymour MM. Racial and Ethnic Differences in the Association between Depressive Symptoms and Cognitive Outcomes in Older Adults: Findings from KHANDLE and STAR. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.07.23295205. [PMID: 37732261 PMCID: PMC10508807 DOI: 10.1101/2023.09.07.23295205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Depressive symptoms are associated with higher risk of dementia but how they impact cognition in diverse populations is unclear. METHODS Asian, Black, LatinX, or White participants (n=2,227) in the Kaiser Healthy Aging and Diverse Life Experiences (age 65+) and the Study of Healthy Aging in African Americans (age 50+) underwent up to three waves of cognitive assessments over four years. Multilevel models stratified by race/ethnicity were used to examine whether depressive symptoms were associated with cognition or cognitive decline and whether associations differed by race/ethnicity. RESULTS Higher depressive symptoms were associated with lower baseline verbal episodic memory scores (-0.06, 95%CI: -0.12, -0.01; -0.15, 95%CI: -0.25, -0.04), and faster decline annually in semantic memory (-0.04, 95%CI: -0.07, -0.01; -0.10, 95%CI: -0.15, -0.05) for Black and LatinX participants. Depressive symptoms were associated with lower baseline but not decline in executive function. DISCUSSION Depressive symptoms were associated with worse cognitive domains, with some evidence of heterogeneity across racial/ethnic groups.
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Affiliation(s)
- Marcia P Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Emma L Gause
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, USA
| | - Eleanor Hayes-Larson
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Evan Fletcher
- Department of Neurology, University of California, Davis, CA, USA
| | - Jennifer Manly
- Department of Neurology, Columbia University, New York, NY, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Yenee Soh
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Maria Corrada
- Department of Epidemiology, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Rachel A Whitmer
- Department of Public Health Sciences and Neurology, University of California Davis School of Medicine, Davis, CA, USA
| | - M Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 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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Hayes-Larson E, Mobley TM, Mungas D, Seamans M, Glymour MM, Gilsanz P, DeCarli C, Whitmer RA, Mayeda ER. Accounting for lack of representation in dementia research: Generalizing KHANDLE study findings on the prevalence of cognitive impairment to the California older population. Alzheimers Dement 2022; 18:2209-2217. [PMID: 35102726 PMCID: PMC9339583 DOI: 10.1002/alz.12522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/13/2021] [Accepted: 10/11/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Most dementia studies are not population-representative; statistical tools can be applied to samples to obtain critically-needed population-representative estimates, but are not yet widely used. METHODS We pooled data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study and the California Behavioral Risk Factor Surveillance System (CA-BRFSS), a population-representative study. Using weights accounting for sociodemographic/health differences between KHANDLE and CA-BRFSS, we estimated cognitive impairment prevalence and age- and sex-adjusted racial/ethnic inequalities in California adults 65+ without prior dementia diagnosis. RESULTS After weighting KHANDLE, the estimated cognitive impairment prevalence in California was 20.3% (95% confidence interval 17.8-23.0); unweighted prevalence was 24.8% (23.1%-26.6%). Inequalities (larger prevalences) were observed among Black and Asian groups versus whites. DISCUSSION We used a novel statistical approach to estimate population-representative cognitive impairment prevalence and inequalities. Such statistical tools can help obtain population-representative estimates from existing studies and inform efforts to reduce racial/ethnic disparities.
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Affiliation(s)
- Eleanor Hayes-Larson
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Taylor M. Mobley
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Dan Mungas
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
- Alzheimer’s Disease Center, University of California Davis Health, Sacramento, CA, USA
| | - Marissa Seamans
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Paola Gilsanz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
- Alzheimer’s Disease Center, University of California Davis Health, Sacramento, CA, USA
| | - Rachel A. Whitmer
- Alzheimer’s Disease Center, University of California Davis Health, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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