1
|
Graves LV, Edmonds EC, Thomas KR, Weigand AJ, Cooper S, Stickel AM, Zlatar ZZ, Clark AL, Bondi MW. Diagnostic accuracy and differential associations between ratings of functioning and neuropsychological performance in non-Hispanic Black and White older adults. Clin Neuropsychol 2022; 36:287-310. [PMID: 34499580 PMCID: PMC8849565 DOI: 10.1080/13854046.2021.1971766] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectiveWe recently demonstrated that relative to consensus-based methods, actuarial methods may improve diagnostic accuracy across the continuum of cognitively normal (CN), mild cognitive impairment (MCI), and dementia in the overall National Alzheimer's Coordinating Center (NACC) cohort. However, the generalizability and comparative utility of current methods of diagnosing MCI and dementia due to Alzheimer's disease and related disorders (ADRD) are significantly understudied in non-Hispanic Black (NHB) older adults. Thus, we extended our previous investigation to more specifically explore the utility of consensus-based and actuarial diagnostic methods in NHB older adults.Method: We compared baseline consensus and actuarial diagnostic rates, and associations of ratings of functioning with neuropsychological performance and diagnostic outcomes, in NHB (n = 963) and non-Hispanic White (NHW; n = 4577) older adults in the NACC cohort.Results: 60.0% of the NHB subsample, versus 29.2% of the NHW subsample, included participants who met actuarial criteria for MCI despite being classified as CN or impaired-not-MCI per consensus. Additionally, associations between ratings of functioning and neuropsychological performance were less consistent in NHB participants than in NHW participants.Conclusions: Our results provide evidence of differential degrees of association between reported functioning and neuropsychological performance in NHB and NHW older adults, which may contribute to racial group differences in diagnostic rates, and prompt consideration of the strengths and weaknesses of consensus-based and actuarial diagnostic approaches in assessing neurocognitive functioning in NHB older adults.
Collapse
Affiliation(s)
- Lisa V. Graves
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Shanna Cooper
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ariana M. Stickel
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Zvinka Z. Zlatar
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
2
|
Mejia-Arango S, Garcia-Cifuentes E, Samper-Ternent R, Borda MG, Cano-Gutierrez CA. Socioeconomic Disparities and Gender Inequalities in Dementia: a Community-Dwelling Population Study from a Middle-Income Country. J Cross Cult Gerontol 2020; 36:105-118. [PMID: 33247379 DOI: 10.1007/s10823-020-09418-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
The proportion of the world's older adults and of its dementia cases is increasing in low and middle-income countries. This is particularly true in Colombia. There, the number of individuals with dementia may increase five-fold by 2050. Yet research is lacking on dementia in such settings. This work estimates the prevalence of dementia in a community-dwelling population in Colombia. It also assesses how gender-based differences in cardiovascular conditions and socioeconomic disparities affect dementia. This work analyzes data on 2000 respondents at least 60 years of age in the Health, Well-Being, And Aging (SABE) study in Bogota. Respondents with dementia are those who have cognitive impairment and at least two limitations in instrumental activities of daily living. The SABE study finds 8.4% of respondents have dementia. Age, cardiovascular risks, and socioeconomic disparities contributed to higher odds of dementia. The contributors to dementia can differ for men and women. For example, socioeconomic disparities were a larger contributor to dementia for women than men. The findings support the cognitive reserve hypothesis on dementia. This holds that pre-existing cognitive processes and compensatory mechanisms influence dementia. Women in Latin America are more likely to suffer from socioeconomic disparities that limit their cognitive reserve. This research points to several policy implications that can help offset these disparities and reduce the prevalence of dementia.
Collapse
Affiliation(s)
- Silvia Mejia-Arango
- Department of Population Studies, El Colegio de la Frontera Norte, Carretera Escénica Km 18.5 San Antonio del Mar, 22560, Tijuana, Baja California, Mexico.
| | - Elkin Garcia-Cifuentes
- Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Miguel G Borda
- Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Unidad de Geriatria, Hospital Universitario San Ignacio, Bogota, Colombia.,Center for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Carlos A Cano-Gutierrez
- Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Unidad de Geriatria, Hospital Universitario San Ignacio, Bogota, Colombia
| |
Collapse
|