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Ly TK, Allen RS, Cundiff JM, DeCaro JA. Investigating the Effects of Discrimination Experiences on Everyday Metamemory Accuracy. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae089. [PMID: 38841817 DOI: 10.1093/geronb/gbae089] [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: 10/11/2023] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVES Lifetime and daily experiences of discrimination contribute to impaired performance on cognitive assessments. However, the underlying mechanism by which discrimination negatively affects cognition is unclear. Recent research investigating stress-induced impairment of metamemory may address the relationship between discrimination experiences and cognitive impairment. METHODS The aim of this study was to determine the relationship of lifetime and daily experiences of discrimination, daily affect balance, baseline objective cognitive performance, and sociodemographic variables (age, race, ethnicity, and sex) with metamemory accuracy across the lifespan (ages 20-75). Impaired metamemory accuracy was defined by the number of subjective cognitive complaints. Diary data from the Midlife in the United States (MIDUS Refresher 1) Daily Diary Project (N = 782) was used for these analyses. RESULTS Results from linear mixed model analyses showed significant within-person effects of daily discrimination, where people who reported more daily discrimination also reported lower metamemory accuracy, and daily affect balance, where people who reported very negative affect also reported lower metamemory accuracy. Additionally, linear mixed model analyses revealed significant between-person effects of race on metamemory accuracy, with individuals from minoritized racial groups generally reporting poorer metamemory accuracy. Daily discrimination experiences also interacted with other variables in predicting day-to-day metamemory accuracy. DISCUSSION These findings add to our understanding of how psychosocial stress in the form of daily discrimination experiences may impair metamemory processes contributing to increased subjective cognitive complaints. Future research should consider the contribution of daily experiences of discrimination across the lifespan to poor cognitive outcomes in later life.
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Affiliation(s)
- Timothy K Ly
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Rebecca S Allen
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jeanne M Cundiff
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jason A DeCaro
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
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Glover CM, Yu L, Lichtenberg PA, Han SD, Lamar M, Stewart CC, Bennett DA, Barnes LL, Boyle PA. Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia. Clin Gerontol 2024:1-17. [PMID: 38992940 DOI: 10.1080/07317115.2024.2375326] [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: 07/13/2024]
Abstract
OBJECTIVES The study aims to identify factors associated with health care and financial decision-making among older Black adults without dementia. METHODS Participants (N = 326) underwent assessments of decision-making and completed measurements of factors from four categories: cognitive, contextual, psychosocial, and personality. We performed separate linear regression models to examine the association between each factor and decision-making and created a fully adjusted model. RESULTS Higher global cognition (estimate = 1.92, SE = 0.21, p < .0001) was associated with better decision-making. Contextual factors including higher current annual income (estimate = 0.23, SE = 0.05, p < .0001), higher childhood socioeconomic status (estimate = 0.48, SE = 0.18, p = .006), higher health and financial literacy (estimate = 0.08, SE = 0.01, p < .0001), and lower financial stress (estimate = -0.19, SE = 0.07, p = .01) were associated with better decision-making. More psychological well-being (estimate = 0.07, SE = 0.22, p = .001), a psychosocial factor, and less neuroticism (estimate = -0.06, SE = 0.02, p = .002), a personality factor, were associated with better decision-making. In the fully adjusted model, two factors, higher global cognition and higher literacy (health and financial), remained associated with better decision-making. CONCLUSIONS Cognitive and contextual factors serve as drivers of decision-making among older Black adults. CLINICAL IMPLICATIONS Clinicians may implement strategies to bolster cognition and improve health and financial literacy to facilitate optimal decision-making among older Black adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Peter A Lichtenberg
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - S Duke Han
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Department of Family Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurology, University of Southern California, Los Angeles, California, USA
- School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Christopher C Stewart
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
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Camacho D, Pacheco K, Moxley J, Aranda MP, Reid C, Wethington E. Loneliness and global cognitive functioning in racially and ethnically diverse US midlife and older adults. Front Psychol 2024; 15:1344044. [PMID: 38962235 PMCID: PMC11221402 DOI: 10.3389/fpsyg.2024.1344044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/15/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Few studies have examined the association of loneliness and cognitive functioning in the US. We used two common measures of loneliness and examined their association in a large sample of US Black, Latino, and White adults (ages ≥ 50). Methods We analyzed Wave 3 of the National Social Life, Health, and Aging Project (N = 2,757). We examined loneliness using one item from the CES-D and the Felt Loneliness Measure (NFLM); cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) tool, where higher scores indicated better functioning. We used weighted ordinary least squares regressions to examine the effects of loneliness (CES-D loneliness and NFLM in separate models) on MoCA scores. In exploratory analyses, we examined if these relationships varied by race and ethnicity. We adjusted all models for sociodemographic and other salient factors (e.g., chronic disease, depressive symptoms, living alone). Results Mean age was 63.49 years, 52% were female, and 9% were Black and 6% Latino persons. Approximately 54% endorsed feeling lonely on at least one measure; 31% (CES-D) and 46% (NFLM). The relationship between loneliness measures was positive and significant, X 2 (1, N = 2,757) = 435.493 p < 0.001. However, only 40% of lonely individuals were identified as lonely on both assessments. CES-D loneliness was inversely (βˆ = -0.274, p = 0.032) associated with MoCA scores and this association did not vary by race and ethnicity. Greater NFLM loneliness was positively associated (βˆ = 0.445, p < 0.001) with higher MoCA scores for Latino participants only. Discussion Loneliness appears to be an important predictor of cognitive functioning. However, the association of loneliness and cognitive functioning varied when using the CES-D loneliness item or the NFLM. Future work is needed to understand how loneliness and its clinically relevant dimensions (social, emotional, existential, chronicity) relate to global and individual cognitive domains. Research is needed with racially and ethnically diverse midlife and older adults, particularly to understand our counterintuitive finding for Latino participants. Finally, findings also support the need for research on interventions to prevent cognitive decline targeting loneliness.
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Affiliation(s)
- David Camacho
- Department of Disability and Human Development, University of Illinois Chicago, Chicago, IL, United States
| | - Kelly Pacheco
- Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Jerad Moxley
- Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Maria P. Aranda
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| | - Cary Reid
- Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Elaine Wethington
- Weill Cornell Medicine, Cornell University, New York, NY, United States
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Hsieh N, Liu H, Zhang Z. Perceived Discrimination and Incident Dementia Among Older Adults in the United States: The Buffering Role of Social Relationships. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae059. [PMID: 38587492 PMCID: PMC11125403 DOI: 10.1093/geronb/gbae059] [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: 04/27/2023] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES Recent studies have found that perceived discrimination as a chronic stressor predicts poorer cognitive health. However, little research has investigated how social relationships as potential intervening mechanisms may mitigate or exacerbate this association. Using a nationally representative sample of U.S. older adults, this study examined how the existence and quality of 4 types of relationships-with a partner, children, other family members, and friends-may modify the impact of perceived discrimination on incident dementia. METHODS We analyzed data from the 2006 to 2016 Health and Retirement Study (N = 12,236) using discrete-time event history models with competing risks. We used perceived discrimination, social relationships, and their interactions at the baseline to predict the risk of incident dementia in the follow-ups. RESULTS Perceived discrimination predicted a higher risk of incident dementia in the follow-ups. Although having a partner or not did not modify this association, partnership support attenuated the negative effects of discrimination on incident dementia. Neither the existence nor quality of relationships with children, other family members, or friends modified the association. DISCUSSION Our findings imply that intimate partnership plays a critical role in coping with discrimination and, consequently, influencing the cognitive health of older adults. Although perceived discrimination is a significant risk factor for the incidence of dementia, better partnership quality may attenuate this association. Policies that eliminate discrimination and interventions that strengthen intimate partnerships may facilitate better cognitive health in late life.
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Affiliation(s)
- Ning Hsieh
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Hui Liu
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Zhenmei Zhang
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
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Harrington EE, Gamaldo AA, Felt JM, Witzel DD, Sliwinski MJ, Murdock KW, Engeland CG, Graham-Engeland JE. Racial differences in links between perceived discrimination, depressive symptoms, and ambulatory working memory. Aging Ment Health 2024:1-9. [PMID: 38738650 DOI: 10.1080/13607863.2024.2351923] [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] [Received: 07/22/2023] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Perceived discrimination is associated with racial cognitive health disparities. Links between discrimination and cognitive performance, like working memory, in everyday settings (i.e. ambulatory performance) require investigation. Depressive symptoms may be a mechanism through which discrimination relates to ambulatory working memory. METHOD Discrimination, retrospective and momentary depressive symptoms/mood, and aggregated and momentary working memory performance among older Black and White adults were examined within the Einstein Aging Study. RESULTS Racially stratified analyses revealed that discrimination did not relate to Black or White adults' ambulatory working memory. Among Black adults, however, more frequent discrimination was associated with greater retrospectively reported depressive symptoms, which related to more working memory errors across two weeks (indirect effect p < 0.05). This path was not significant among White adults. Links between discrimination and momentary working memory were not explained by momentary reports of depressed mood for Black or White adults. CONCLUSION Depressive symptoms may play an important role in the link between discrimination and ambulatory working memory among Black adults across extended measurements, but not at the momentary level. Future research should address ambulatory cognition and momentary reports of discrimination and depression to better understand how to minimize cognitive health disparities associated with discrimination.
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Affiliation(s)
- Erin E Harrington
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Psychology, University of Wyoming, Laramie, WY, USA
| | | | - John M Felt
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Dakota D Witzel
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kyle W Murdock
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol, Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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Simons RL, Ong ML, Lei M, Beach SRH, Zhang Y, Philibert R, Mielke MM. Racial discrimination during middle age predicts higher serum phosphorylated tau and neurofilament light chain levels a decade later: A study of aging black Americans. Alzheimers Dement 2024; 20:3485-3494. [PMID: 38597292 PMCID: PMC11095429 DOI: 10.1002/alz.13751] [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: 09/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Recent evidence suggests that exposure to the stress of racism may increase the risk of dementia for Black Americans. METHODS The present study used 17 years of data from a sample of 255 Black Americans to investigate the extent to which exposure to racial discrimination predicts subsequent changes in serum Alzheimer's Disease Research Center (ADRC) biomarkers: serum phosphorylated tau181(p-tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP). We hypothesized that racial discrimination assessed during middle age would predict increases in these serum biomarkers as the participants aged into their 60s. RESULTS Our findings indicate that exposure to various forms of racial discrimination during a person's 40s and early 50s predicts an 11-year increase in both serum p-tau181 and NfL. Racial discrimination was not associated with subsequent levels of GFAP. DISCUSSION These findings suggest that racial discrimination in midlife may contribute to increased AD pathology and neurodegeneration later in life. HIGHLIGHTS A 17-year longitudinal study of Black Americans. Assessments of change in serum p-tau181, neurofilament light, and glial fibrillary acidic protein. Exposure to racial discrimination during middle age predicted increases in p-tau181 and neurofilament light. Education was positively related to both p-tau181 and exposure to racial discrimination.
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Affiliation(s)
| | - Mei Ling Ong
- Center for Family ResearchUniversity of GeorgiaAthensGeorgiaUSA
| | - Man‐Kit Lei
- Department of SociologyUniversity of GeorgiaAthensGeorgiaUSA
| | | | - Yue Zhang
- Department of SociologyUniversity of GeorgiaAthensGeorgiaUSA
| | - Robert Philibert
- Department of PsychiatryUniversity of Iowa School of MedicineIowa CityIowaUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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7
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Lange-Maia BS, James BD, Capuano AW, Grodstein F, Chen Y, Barnes LL. Everyday Discrimination Is Associated With Higher Odds of Hospitalizations Among Older African Americans. J Gerontol A Biol Sci Med Sci 2024; 79:glae089. [PMID: 38549555 PMCID: PMC11046980 DOI: 10.1093/gerona/glae089] [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: 08/28/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Everyday discrimination-experiences of being treated unfairly based on background characteristics like race-is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher odds of being hospitalized in older African Americans has not been explored. METHODS Community-dwelling participants from 3 longitudinal cohort studies (N = 446, age 65+ years) with discrimination scores and ≥12 months of linked Medicare claims were included. Hospitalizations were identified using Medicare fee-for-service claims, available for an average of 6.2 (SD: 3.7) years of follow-up after baseline. RESULTS In mixed-effects ordinal logistic regression models (outcomes of 0, 1, or 2+ hospitalizations per year) adjusted for age, sex, education, and income, higher discrimination was associated with higher odds of total annual hospitalizations (odds ratio [OR] per point higher = 1.09, 95% confidence intervals [95% CI]: 1.02-1.17). Results were similar when accounting for depressive symptoms. CONCLUSIONS Higher exposure to everyday discrimination is associated with higher odds of hospitalization among older African Americans. Mechanisms underlying associations should be explored further to understand how hospitalizations may be reduced in older African Americans.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Family and Preventive Medicine, Rush Medical College, Chicago, Illinois, USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan D James
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush Medical College, Chicago, Illinois, USA
| | - Ana W Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush Medical College, Chicago, Illinois, USA
| | - Yi Chen
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
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Chakraborty J, Kundu S. Drivers of perceived discrimination among older adults in India: an intersectional analysis. BMC Psychol 2024; 12:196. [PMID: 38600603 PMCID: PMC11005162 DOI: 10.1186/s40359-024-01697-7] [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: 08/16/2023] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
Discrimination is harmful action taken against individuals or groups to protect customary relations of power and privilege. Older adults are particularly vulnerable to experiences of discrimination that adversely affect their quality of life. We use data from the Longitudinal Ageing Study of India (LASI; Wave 1; 2017-2018) to examine different contextual forces that shape the experiences of discrimination in older adults in India, specifically gender, caste, and economic condition. We used the theory of intersectionality to hypothesize that economic condition, caste, and gender combine uniquely to engender perceived discrimination in older adults. We first used a concentration index to determine the sample's pre-existing inequality levels. The concentration curve evidenced a disproportionate concentration of discrimination among people with low income. Next, we used a three-way ANCOVA to examine the effects of caste, gender, and economic condition on individuals' experiences of discrimination. A significant interaction effect of caste, gender, and economic condition [F(1, 30,394) = 8.91 p = 0.003] evidenced the compounding effects of inequalities on experiences of discrimination. Finally, we ran a moderation model to test the ameliorating effects of education on experiences of discrimination experienced by marginalized castes. The model was significant (β= -0.192; p < 0.001), thereby supporting the proposition that increased education level can lead to an increased sense of belonging and perceptions of equal treatment, which relate negatively to perceived discrimination. Results are discussed considering intersectionality in peoples' struggles and resilience in India.
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Affiliation(s)
- Jayantika Chakraborty
- Frances L. Hiatt School of Psychology, Clark University, Worcester, Massachusetts, United States
| | - Sampurna Kundu
- Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, 110067, Delhi, India.
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Amano T, Jia Y, Redding A. The dynamic and reciprocal relationship between perceived everyday discrimination and cognitive function in later life. Aging Ment Health 2024:1-11. [PMID: 38590239 DOI: 10.1080/13607863.2024.2338196] [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] [Received: 10/10/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES This study, based on socioemotional selectivity theory and cognitive theory, investigates the dynamic and reciprocal relationship between perceived discrimination and cognitive function in later life. METHODS Data were drawn from four waves of the Health and Retirement Study (HRS 2006, 2010, 2014, and 2018). A total of 4,125 people who were 51 and older were included. Cognitive function was measured by the telephone interview for cognitive status (TICS-27). Perceived discrimination was measured using scores of the perceived everyday discrimination scale. Random intercept cross-lagged panel model (RI-CLPM) was utilized. The model was adjusted for a range of covariates. Subgroup analysis by ethnoracial groups was conducted. RESULTS Cross-sectionally, while lower cognitive function was associated with higher perceived discrimination, this relationship was unidirectional. Longitudinally, higher perceived discrimination predicted lower cognitive function in later waves only among non-Hispanic White individuals. CONCLUSION Results suggested that a decline in cognitive function may precede and contribute to the worsening of perceived discrimination, which may result in further decline in cognitive function. Lifetime experience of discrimination was discussed as a possible source of the racial/ethnic variations in the relationship. Further study is needed to examine whether this relationship holds among people with cognitive impairment and dementia.
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Affiliation(s)
- Takashi Amano
- Department of Social Work, School of Arts and Sciences, Rutgers University, Newark, New Jersey, USA
| | - Yuane Jia
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Audrey Redding
- Department of Social Work, School of Arts and Sciences, Rutgers University, Newark, New Jersey, USA
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McKinney WS, Williford DN, Abbeduto L, Schmitt LM. The impact of social-environmental factors on IQ in syndromic intellectual developmental disabilities. J Clin Transl Sci 2024; 8:e59. [PMID: 38655457 PMCID: PMC11036438 DOI: 10.1017/cts.2024.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Despite having the same underlying genetic etiology, individuals with the same syndromic form of intellectual developmental disability (IDD) show a large degree of interindividual differences in cognition and IQ. Research indicates that up to 80% of the variation in IQ scores among individuals with syndromic IDDs is attributable to nongenetic effects, including social-environmental factors. In this narrative review, we summarize evidence of the influence that factors related to economic stability (focused on due to its prevalence in existing literature) have on IQ in individuals with syndromic IDDs. We also highlight the pathways through which economic stability is hypothesized to impact cognitive development and drive individual differences in IQ among individuals with syndromic IDDs. We also identify broader social-environmental factors (e.g., social determinants of health) that warrant consideration in future research, but that have not yet been explored in syndromic IDDs. We conclude by making recommendations to address the urgent need for further research into other salient factors associated with heterogeneity in IQ. These recommendations ultimately may shape individual- and community-level interventions and may inform systems-level public policy efforts to promote the cognitive development of and improve the lived experiences of individuals with syndromic IDDs.
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Affiliation(s)
- Walker S. McKinney
- Department of Behavioral Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA
| | - Desireé N. Williford
- Department of Behavioral Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis,
Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University
of California Davis, Sacramento, CA,
USA
| | - Lauren M. Schmitt
- Department of Behavioral Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
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11
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Dixon JS, Wang D, Ready RE. Discrimination and Cognition in Midlife Black Women: The Roles of Social Support and Spirituality. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad201. [PMID: 38165061 PMCID: PMC10939168 DOI: 10.1093/geronb/gbad201] [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: 04/23/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition. METHODS Participants were midlife Black women (N = 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors. RESULTS Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition. DISCUSSION Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.
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Affiliation(s)
- Jasmine S Dixon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Dongwei Wang
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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12
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Lamar M, Arfanakis K, Evia A, Makkinejad N, Capuano AW, Kim N, Leurgans SE, Fleischman DA, Duke Han S, Poole V, Barnes LL. Changes in an in-vivo classifier of ARTerioloSclerosis (ARTS) with simultaneous change in cognition for older African Americans. Neurobiol Aging 2024; 134:21-27. [PMID: 37979249 PMCID: PMC10845033 DOI: 10.1016/j.neurobiolaging.2023.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
At autopsy, African American decedents often have mixed Alzheimer's and cerebrovascular brain pathologies including arteriolosclerosis. We applied a novel in-vivo classifier of ARTerioloSclerosis (ARTS) in 167 older African Americans (∼75y of age) with > 2 biennial 3 T MRI scans and > 3 years of associated cognitive follow-up to determine if ARTS scores (higher score=higher likelihood of arteriolosclerosis) changed over time and if this change associated with changes in cognition in the same individuals. Mixed effects regression models tested whether ARTS scores increased over time, while simultaneous mixed effects regression models estimated the simultaneous rates of change in both ARTS and cognition and the correlation of these changes. ARTS scores increased over time (estimate=0.030, SE=0.002, p < 0.0001). Faster increases in ARTS were associated with faster rates of global cognitive decline (r = -0.447, p = 0.006) and domain-specific cognitive functions. Applying an in-vivo marker of arteriolosclerosis in an African American cohort revealed that the likelihood of arteriolosclerosis increases over time, and participants whose ARTS scores increased more rapidly tended to have faster than average rates of cognitive decline.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, USA; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Nazanin Makkinejad
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Namhee Kim
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - S Duke Han
- Rush Alzheimer's Disease Center, USA; Department of Family Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Victoria Poole
- Rush Alzheimer's Disease Center, USA; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Estrella ML, Tarraf W, Kuwayama S, Gallo LC, Wu B, Marquine MJ, Perreira KM, Vasquez PM, Isasi CR, Lipton RB, Mattei J, González HM, Daviglus ML, Lamar M. Psychosocial factors associated with 7-year change in cognition among middle-aged and older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and Sociocultural ancillary studies. Alzheimers Dement 2024; 20:1137-1148. [PMID: 37897802 PMCID: PMC10916974 DOI: 10.1002/alz.13527] [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: 04/26/2023] [Revised: 08/02/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Few studies have examined the associations of psychosocial factors with cognitive change in Hispanics/Latinos. METHODS Data from the Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL INCA) and Sociocultural studies were used (n = 2,155; ages ≥45 years). Psychosocial exposures included intrapersonal (ethnic identity, optimism, purpose in life), interpersonal (family cohesion, familism, social networks, social support), and social factors (ethnic discrimination, loneliness, subjective social status). Survey-linear regression models examined associations between psychosocial exposures and 7-year cognitive change (global cognition [GC], verbal learning, memory, word fluency [WF], and digit symbol substitution [DSS]). RESULTS Familism predicted decline in GC, verbal learning, and memory; family cohesion predicted DSS decline; and loneliness predicted memory decline. Ethnic identity was protective against decline in GC and memory, optimism and social support were protective against decline in memory, and purpose in life was protective against WF decline. DISCUSSION Psychosocial factors are differentially related to cognitive changes. Culturally relevant factors should be explored in Hispanic/Latino cognitive aging research. HIGHLIGHTS Psychosocial factors are differentially related to cognitive changes in Latinos. Role of culturally relevant factors on cognition should be further explored. Familism predicted decline in global cognition, verbal learning, and memory. Ethnic identity predicted increase in global cognition and memory.
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Affiliation(s)
- Mayra L. Estrella
- Department of EpidemiologyHuman Genetics and Environmental SciencesUniversity of Texas Health Sciences Center at Houston (UTHealth Houston) School of Public HealthBrownsvilleTexasUSA
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Sayaka Kuwayama
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Benson Wu
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - María J. Marquine
- Departments of Medicine and PsychiatryDuke Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Krista M. Perreira
- Department of Social MedicineUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Priscilla M. Vasquez
- Department of Urban Public HealthCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Carmen R. Isasi
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Department of NeurologyAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Josiemer Mattei
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Hector M. González
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Martha L. Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
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Rosario MA, Alotaibi R, Espinal-Martinez AO, Ayoub A, Baumann A, Clark U, Cozier Y, Schon K. Personal Mastery Attenuates the Association between Greater Perceived Discrimination and Lower Amygdala and Anterior Hippocampal Volume in a Diverse Sample of Older Adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.12.575447. [PMID: 38293042 PMCID: PMC10827091 DOI: 10.1101/2024.01.12.575447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
There is limited research investigating whether perceived discrimination influences brain structures that subserve episodic memory, namely the hippocampus and amygdala. Our rationale for examining these regions build on their known sensitivity to stress and functional differences along the long-axis of the hippocampus, with the anterior hippocampus and amygdala implicated in emotional and stress regulation. We defined perceived discrimination as the unfair treatment of one group by a dominant social group without the agency to respond to the event. A potential moderator of perceived discrimination is personal mastery, which we operationally defined as personal agency. Our primary goals were to determine whether perceived discrimination correlated with amygdala and anterior hippocampal volume, and if personal mastery moderated these relationships. Using FreeSurfer 7.1.0, we processed T1-weighted images to extract bilateral amygdala and hippocampal volumes. Discrimination and personal mastery were assessed via self-report (using the Experiences of Discrimination and Sense of Control questionnaires, respectively). Using multiple regression, greater perceived discrimination correlated with lower bilateral amygdala and anterior hippocampal volume, controlling for current stress, sex, education, age, and intracranial volume. Exploratory subfield analyses showed these associations were localized to the anterior hippocampal CA1 and subiculum. As predicted, using a moderation analysis, personal mastery attenuated the relationship between perceived discrimination and amygdala and anterior hippocampal volume. Here, we extend our knowledge on perceived discrimination as a salient psychosocial stressor with a neurobiological impact on brain systems implicated in stress, memory, and emotional regulation, and provide evidence for personal mastery as a moderating factor of these relationships.
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Affiliation(s)
- Michael A Rosario
- Graduate Program for Neuroscience, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
- Center for Systems Neuroscience, Boston University, 610 Commonwealth Avenue, 7 Floor, Boston, MA 02215, USA
| | - Razan Alotaibi
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
- Center for Systems Neuroscience, Boston University, 610 Commonwealth Avenue, 7 Floor, Boston, MA 02215, USA
| | - Alan O Espinal-Martinez
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Amara Ayoub
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Aletha Baumann
- Department of Psychology, University of the Virgin Islands, RR02 Box 10000, St. Croix, USVI 00823, USA
| | - Uraina Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yvette Cozier
- Slone Epidemiology Center, Boston University, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Karin Schon
- Graduate Program for Neuroscience, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
- Center for Systems Neuroscience, Boston University, 610 Commonwealth Avenue, 7 Floor, Boston, MA 02215, USA
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Tibiriçá L, Jester DJ, Kohn JN, Williams AP, McEvoy LK, Palmer BW. Perceived discrimination and nativity status: risk of cognitive impairment among Latin American older adults. Int Psychogeriatr 2023:1-13. [PMID: 38037791 DOI: 10.1017/s1041610223004374] [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: 12/02/2023]
Abstract
OBJECTIVES We examined the association between perceived discrimination and the risk of cognitive impairment with no dementia (CIND) and Alzheimer's disease and related dementias (ADRD) while considering the potential effects of nativity status. DESIGN A prospective analysis of discrimination and nativity status with dementia and cognitive impairment was conducted among Latinx adults aged 51 years and older who participated in the Health and Retirement Study. SETTING A national representative sample. PARTICIPANTS A sample of 1,175 Latinx adults aged 51 years and older. MEASUREMENTS Demographics, cognitive functioning, perceived discrimination, and nativity status (US-born vs. non-US born) were assessed. Traditional survival analysis methods (Fine and gray models) were used to account for the semi-competing risk of death with up to 10 years of follow-up. RESULTS According to our results, neither everyday discrimination nor nativity status on their own had a statistically significant association with CIND/ADRD; however, non-US-born Latinx adults who reported no discrimination had a 42% lower risk of CIND/ADRD (SHR = 0.58 [0.41, 0.83], p = .003) than US-born adults. CONCLUSIONS These results highlight the need for healthcare providers to assess for discrimination and provide support and resources for those experiencing discrimination. It also highlights the need for better policies that address discrimination and reduce health disparities.
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Affiliation(s)
- Lize Tibiriçá
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dylan J Jester
- Women's Operational Military Exposure Network (WOMEN), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jordan N Kohn
- Department of Psychiatry, University of California, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Allison P Williams
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Linda K McEvoy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education and Clinical Center (MIRECC), San Diego, CA, USA
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Walsemann KM, Hair NL, Farina MP, Tyagi P, Jackson H, Ailshire JA. State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults. Soc Sci Med 2023; 338:116319. [PMID: 37871395 PMCID: PMC10872867 DOI: 10.1016/j.socscimed.2023.116319] [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: 03/30/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
RATIONALE Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function. OBJECTIVE We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment. METHODS We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects. RESULTS Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment. CONCLUSIONS Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.
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17
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Tian YM, Wang J, Zhang WS, Jiang CQ, Jin YL, Zhu T, Zhu F, Cheng KK, Lam TH, Xu L. Association of perceived stress with memory decline in older Chinese: The Guangzhou Biobank Cohort Study. J Affect Disord 2023; 341:256-264. [PMID: 37634823 DOI: 10.1016/j.jad.2023.08.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Previous studies on associations of perceived stress with poor memory performance in older adults showed inconsistent results. We examined the prospective associations of perceived stress with memory decline using data from Guangzhou Biobank Cohort Study (GBCS). METHODS Perceived stress was measured by the Perceived Stress Scale (PSS) at baseline (2003-2006), with greater scores indicating greater stress. Memory function was measured by delayed 10-word recall test (DWRT) and immediate 10-word recall test (IWRT), with greater scores indicating better performance, at baseline and follow-up (2008-2012) examinations, analyzed as mean annual change in scores. RESULTS 9656 participants (72 % women) with mean age 61.6 (standard deviation = 6.4) years were included. During an average of 4.4 years of follow-up, after adjusting for confounders, each one-point greater PSS score was associated with mean annual decline in DWRT scores (β (95 % CI) = -0.005 (-0.008 to -0.002)). Greater Perceived Helplessness (PH) scores, but not Perceived Self-efficacy scores, was associated with greater mean annual decline in DWRT and IWRT scores (β (95 % CI) = -0.005 (-0.009 to -0.001) and - 0.012 (-0.018 to -0.005), respectively), and similar patterns were observed in five out of seven PH items (βs from -0.02 to -0.07). Interaction analysis showed that the association of greater PSS with greater decline in DWRT scores was observed only in those with low family income (β (95 % CI) = -0.08 (-0.13 to -0.04), P for interaction = 0.03). CONCLUSIONS Greater perceived stress was associated with a greater decline in delayed recall memory, especially in those with low family income.
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Affiliation(s)
- Yu Meng Tian
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiao Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Sen Zhang
- Guangzhou Twelfth People's Hospital, Guangzhou, China.
| | | | - Ya Li Jin
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Tong Zhu
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tai Hing Lam
- School of Public Health, the University of Hong Kong, Hong Kong
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China; School of Public Health, the University of Hong Kong, Hong Kong; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Ng WQ, Ng GR, Yang H. Sense of Control Mediates the Relation between Discrimination and Executive Functions in Middle-Aged and Older Adults: A Structural Equation Modeling Approach. Exp Aging Res 2023; 49:501-515. [PMID: 36214758 DOI: 10.1080/0361073x.2022.2132073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite previous findings of a negative association between everyday discrimination and executive functions (EF) - a set of domain-general cognitive control processes - in middle-aged and older adults, less is known about the underlying mechanism. Thus, we focused on sense on control and its two facets - perceived constraints and personal mastery - as potential psychosocial mediators of this relation. METHODS By analyzing a nationally representative adult cohort from the Midlife Development in the United States (MIDUS) 2 study, we examined two mediational models: a single mediation model with sense of control and a parallel mediation model with perceived constraints and personal mastery as mediators. RESULTS Structural equation modeling analyses showed that sense of control, as well as personal mastery and perceived constraints, mediated the relationship between discrimination and EF in middle-aged and older adults. This held true when we controlled for age, race, gender, education, and health status. CONCLUSION Our findings underscore the unique and distinctive roles of sense of control and its two facets in the relation between everyday discrimination and EF in middle-aged and older adults.
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Affiliation(s)
- Wee Qin Ng
- School of Social Sciences, Singapore Management University, Singapore, Singapore
| | - Gilaine Rui Ng
- School of Social Sciences, Singapore Management University, Singapore, Singapore
| | - Hwajin Yang
- School of Social Sciences, Singapore Management University, Singapore, Singapore
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Dark HE, Huang A, Cordon J, Deal JA, Palta P, Windham BG, Barnes LL, Kucharska-Newton A, Mosley T, Gottesman RF, Sims M, Griswold M, Rentería MA, Manly JJ, Walker KA. The association of perceived discrimination with dementia risk in Black older adults. Alzheimers Dement 2023; 19:4346-4356. [PMID: 37218405 PMCID: PMC10734390 DOI: 10.1002/alz.13135] [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: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Non-Hispanic Black, compared to non-Hispanic White, older adults are at increased risk for dementia. This may be due partly to greater exposure to psychosocial stressors, such as discrimination; however, few studies have examined this association. METHODS We examined the association of perceived discrimination (e.g., everyday, lifetime, and discrimination burden) with dementia risk in 1583 Black adults co-enrolled in the Atherosclerosis Risk in Communities (ARIC) Study and the Jackson Heart Study (JHS). Perceived discrimination (defined continuously and using tertiles) was assessed at JHS Exam 1 (2000-2004; mean age ± SD:66.2 ± 5.5) and related to dementia risk through ARIC visit 6 (2017) using covariate-adjusted Cox proportional hazards models. RESULTS Associations of perceived everyday, lifetime, and burden of discrimination with dementia risk were not supported in age-adjusted models or demographic- and cardiovascular health-adjusted models. Results were similar across sex, income, and education. DISCUSSION In this sample, associations between perceived discrimination and dementia risk were not supported. HIGHLIGHTS In Black older adults perceived discrimination not associated with dementia risk. Younger age and greater education linked to greater perceived discrimination. Older age and less education among factors associated with dementia risk. Factors increasing exposure to discrimination (education) are also neuroprotective.
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Affiliation(s)
- Heather E. Dark
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Jenifer Cordon
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Jennifer A. Deal
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, 10032, USA
| | - B. Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences at Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer’s Disease Center at Rush University Medical Center, Chicago, IL, 60612, USA
| | - Anna Kucharska-Newton
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Program, NIH, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Michael Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Miguel Arce Rentería
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
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Franco-Rocha OY, Lewis KA, Longoria KD, De La Torre Schutz A, Wright ML, Kesler SR. Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review. J Cancer Res Clin Oncol 2023; 149:12561-12587. [PMID: 37432455 DOI: 10.1007/s00432-023-05088-0] [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: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. METHODS We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. RESULTS Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. CONCLUSIONS Our findings indicate that racial and ethnic minoritized individuals may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA.
| | - Kimberly A Lewis
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kayla D Longoria
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Alexa De La Torre Schutz
- Brain Health Neuroscience Lab, School of Nursing, The University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
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Manca R, Venneri A. Minority Stress and Psychosocial Influences on Cognitive Performance in Sexual Minority Older Adults. Innov Aging 2023; 7:igad110. [PMID: 37868765 PMCID: PMC10590172 DOI: 10.1093/geroni/igad110] [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: 04/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background and Objectives Sexual minorities experience health inequalities, but little is known about differences in neurocognitive health between heterosexual and sexual minority older adults and potential risk factors. To investigate minority stress, depression, and marital status as risk factors for worse cognitive performance in sexual minority older adults. Research Design and Methods A total of 336 sexual minorities and 5,561 heterosexual participants aged 50+, noninstitutionalized, and free from neurodegenerative diseases from Wave 6 of the English Longitudinal Study of Ageing were included. Cognitive performance (i.e., temporal orientation, episodic memory, and fluid intelligence) of sexual minority and heterosexual older adults was compared using general linear models including age, sex, and education as covariates. The differential impact of minority stress, depressive symptoms, and marital status on cognition in the 2 groups were also tested. Analyses were weighted for sampling probability and differential nonresponse. Results Sexual minority participants were more likely to report minority stress and to be single but had better episodic memory than heterosexual participants. Depression and being single were associated with worse cognitive performance in both groups. However, minority stress was negatively associated (B = -2.116, p = .016) with fluid intelligence in the sexual minority group only. Discussion and Implications Better memory in sexual minority participants and a negative effect of risk factors on cognition are in line with previous studies. However, this study provides the first evidence of a potential negative impact of minority stress on cognitive performance in sexual minorities. Further investigations are needed to assess minority stress more in detail and clarify its potential mechanisms of action on cognition in sexual minorities.
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Affiliation(s)
- Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge, UK
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge, UK
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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22
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Muñoz E, Yan J, Tse HW, Zavala D, López BG, Kim SY. Prospective Effects of Discrimination, Depressive Symptoms, and Cognitive Control Among Mexican-Origin Women. J Gerontol B Psychol Sci Soc Sci 2023; 78:1294-1304. [PMID: 36881689 PMCID: PMC10394994 DOI: 10.1093/geronb/gbad042] [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: 09/29/2022] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES Cognitive control predicts functional independence and cognitive health outcomes, but is yet to be known the extent to which social stress, like discrimination, may diminish cognitive control capacities in Mexican-origin women. We evaluated the prospective associations between everyday and ethnic discrimination on cognitive control and examined the mediating effects of depressive symptoms on these links. We further examined the extent to which associations varied by age and financial strain. METHODS We used data from 596 Mexican-origin women (average age = 38.89, standard deviation = 5.74) who participated in a 3-wave longitudinal study spanning 8 years (from 2012 to 2020). Participants completed measures of everyday and ethnic discrimination at Wave 1, depressive symptoms in Waves 1 and 2, and completed computer-based tasks of cognitive control at Wave 3. Self-reported assessments of financial strain were completed at Wave 2. Moderated mediation structural equation models were implemented to test hypotheses. RESULTS Depressive symptoms significantly mediated the prospective association between everyday/ethnic discrimination to cognitive control. Higher levels of everyday and ethnic discrimination at baseline were associated with more depressive symptoms at Wave 2, which were then related to poorer cognitive control (i.e., longer reaction time in congruent and/or incongruent trials) at Wave 3. There was no significant moderation of age. Among those with low financial strain, higher levels of everyday discrimination were related to faster response times. DISCUSSION Results revealed the long-term consequences of experiences with discrimination on cognitive control that operate through increased depressive symptoms and that may have some subtle differential effects across levels of financial strain.
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Affiliation(s)
- Elizabeth Muñoz
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Jinjin Yan
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Hin Wing Tse
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Daisy Zavala
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Belem G López
- National Institutes of Health, Bethesda, Maryland,USA
| | - Su Yeong Kim
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas, USA
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23
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Dong TS, Gee GC, Beltran-Sanchez H, Wang M, Osadchiy V, Kilpatrick LA, Chen Z, Subramanyam V, Zhang Y, Guo Y, Labus JS, Naliboff B, Cole S, Zhang X, Mayer EA, Gupta A. How Discrimination Gets Under the Skin: Biological Determinants of Discrimination Associated With Dysregulation of the Brain-Gut Microbiome System and Psychological Symptoms. Biol Psychiatry 2023; 94:203-214. [PMID: 36754687 PMCID: PMC10684253 DOI: 10.1016/j.biopsych.2022.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Discrimination is associated with negative health outcomes as mediated in part by chronic stress, but a full understanding of the biological pathways is lacking. Here we investigate the effects of discrimination involved in dysregulating the brain-gut microbiome (BGM) system. METHODS A total of 154 participants underwent brain magnetic resonance imaging to measure functional connectivity. Fecal samples were obtained for 16S ribosomal RNA profiling and fecal metabolites and serum for inflammatory markers, along with questionnaires. The Everyday Discrimination Scale was administered to measure chronic and routine experiences of unfair treatment. A sparse partial least squares-discriminant analysis was conducted to predict BGM alterations as a function of discrimination, controlling for sex, age, body mass index, and diet. Associations between discrimination-related BGM alterations and psychological variables were assessed using a tripartite analysis. RESULTS Discrimination was associated with anxiety, depression, and visceral sensitivity. Discrimination was associated with alterations of brain networks related to emotion, cognition and self-perception, and structural and functional changes in the gut microbiome. BGM discrimination-related associations varied by race/ethnicity. Among Black and Hispanic individuals, discrimination led to brain network changes consistent with psychological coping and increased systemic inflammation. For White individuals, discrimination was related to anxiety but not inflammation, while for Asian individuals, the patterns suggest possible somatization and behavioral (e.g., dietary) responses to discrimination. CONCLUSIONS Discrimination is attributed to changes in the BGM system more skewed toward inflammation, threat response, emotional arousal, and psychological symptoms. By integrating diverse lines of research, our results demonstrate evidence that may explain how discrimination contributes to health inequalities.
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Affiliation(s)
- Tien S Dong
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California; Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Gilbert C Gee
- Department of Community Health Sciences Fielding School of Public Health, Los Angeles, California; California Center for Population Research, University of California, Los Angeles, Los Angeles, California
| | - Hiram Beltran-Sanchez
- Department of Community Health Sciences Fielding School of Public Health, Los Angeles, California; California Center for Population Research, University of California, Los Angeles, Los Angeles, California
| | - May Wang
- Department of Community Health Sciences Fielding School of Public Health, Los Angeles, California
| | - Vadim Osadchiy
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lisa A Kilpatrick
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Zixi Chen
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Vishvak Subramanyam
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Yurui Zhang
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Yinming Guo
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California
| | - Jennifer S Labus
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Bruce Naliboff
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Steve Cole
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry & Biobehavioral Sciences and Medicine, University of California, Los Angeles, Los Angeles, California
| | - Xiaobei Zhang
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Emeran A Mayer
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California
| | - Arpana Gupta
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; UCLA Microbiome Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; G. Oppenheimer Center for Neurobiology of Stress and Resilience, University of California, Los Angeles, Los Angeles, California.
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24
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Fields NL, Xu L, Williams IC, Gaugler JE, Cipher DJ, Cassidy J, Feinhals G. The Senior Companion Program Plus: An Innovative Training Approach for Alzheimer's Disease and Related Dementia. Healthcare (Basel) 2023; 11:1966. [PMID: 37444800 PMCID: PMC10341164 DOI: 10.3390/healthcare11131966] [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: 05/25/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
African Americans adults are disproportionately affected by Alzheimer's disease and related dementias (ADRD) and are underrepresented in research about ADRD. Reducing gaps in the knowledge about ADRD in the African American community is important for addressing dementia care disparities. The existing psychoeducation interventions are often limited by cost and scalability; for these reasons, lay provider (i.e., volunteer) interventions are of increasing interest in ADRD research. The purpose of this study was to evaluate a training of African American Senior Companion (SC) volunteers (n = 11) with dementia-specific knowledge (i.e., Senior Companion Program/SCP Plus), as part of a culturally informed, in-home, psychoeducational intervention for African American ADRD family caregivers. Learning outcomes were measured pre- and post-training, using the Knowledge of Alzheimer's Disease/dementia scale (KAD), the Sense of Competence Questionnaire, and the Preparedness for Caregiving Scale. The results showed significant improvements in knowledge of Alzheimer's disease/dementia, one competence item, "It is clear to me how much care my care recipient needs", and preparedness for caregiving. Overall, the study findings suggest the SCP Plus is a promising, culturally relevant, and potentially scalable lay provider training for ADRD with potential benefits that augment the existing Senior Companion Program.
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Affiliation(s)
- Noelle L. Fields
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA; (L.X.); (J.C.)
| | - Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA; (L.X.); (J.C.)
| | - Ishan C. Williams
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Joseph E. Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Daisha J. Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Jessica Cassidy
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA; (L.X.); (J.C.)
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25
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Cintron DW, Calmasini C, Barnes LL, Mungas DM, Whitmer RA, Eng CW, Gilsanz P, George KM, Peterson R, Glymour MM. Evaluating interpersonal discrimination and depressive symptoms as partial mediators of the effects of education on cognition: Evidence from the Study of Healthy Aging in African Americans (STAR). Alzheimers Dement 2023; 19:3138-3147. [PMID: 36724372 PMCID: PMC10390650 DOI: 10.1002/alz.12957] [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: 08/03/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Education is correlated with positive health outcomes, but associations are sometimes weaker among African Americans. The extent to which exposure to discrimination and depressive symptoms attenuates the education-cognition link has not been investigated. METHODS Study of Healthy Aging in African Americans (STAR) participants (n = 764; average age 69 years) completed the Spanish and English Neuropsychological Assessment Scales. We assessed everyday and major lifetime discrimination and depressive symptoms as mediators of education effects on cognition using G-estimation with measurement error corrections. RESULTS Education was correlated with greater major lifetime and everyday discrimination but lower depressive symptoms. Accounting for discrimination and depressive symptoms slightly reduced the estimated effect of education on cognition. The estimated total effect of graduate education (vs DISCUSSION Education has robust effects on later-life cognition after controlling multiple mediating pathways and offsetting mechanisms.
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Affiliation(s)
- Dakota W. Cintron
- Center for Health and Community, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Camilla Calmasini
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Dan M. Mungas
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Chloe W. Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Paola Gilsanz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kristen M. George
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Rachel Peterson
- Department of Neurology, University of California Davis Health, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - M. Maria Glymour
- Center for Health and Community, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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26
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Bancks MP, Byrd G, Caban-Holt A, Fitzpatrick AL, Forrester SN, Hayden KM, Heckbert SR, Kershaw KN, Rapp SR, Sachs BC, Hughes TM. Self-reported experiences of discrimination and incident dementia. Alzheimers Dement 2023; 19:3119-3128. [PMID: 36724324 PMCID: PMC10390651 DOI: 10.1002/alz.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/09/2022] [Accepted: 12/20/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Discrimination negatively impacts health and may contribute to racial/ethnic disparities in dementia risk. METHODS Experiences of lifetime and everyday discrimination were assessed among 6509 Multi-Ethnic Study of Atherosclerosis (MESA) participants. We assessed the association of discrimination with incidence of dementia including adjustment for important risk factors, cohort attrition, and we assessed for effect modification by race/ethnicity. RESULTS Prevalence of any lifetime discrimination in MESA was 42%, highest among Black adults (72%). Over a median 15.7 years of follow-up, there were 466 incident cases of dementia. Lifetime discrimination, but not everyday discrimination, was associated with incident dementia (Wald p = 0.03). Individuals reporting lifetime discrimination in ≥2 domains (compared to none) had greater risk for dementia (hazard ratio: 1.40; 95%: 1.08, 1.82) after adjustment for sociodemographic, clinical, and behavioral risk factors. Associations did not differ by race/ethnicity. CONCLUSIONS These findings demonstrate an association of greater experiences of lifetime discrimination with incident dementia.
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Affiliation(s)
| | - Goldie Byrd
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | - Stephen R. Rapp
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bonnie C. Sachs
- Wake Forest University School of Medicine, Winston-Salem, NC
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27
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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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28
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Lamar M, Kershaw KN, Leurgans SE, Mukherjee RR, Lange-Maia BS, Marquez DX, Barnes LL. Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults. Front Hum Neurosci 2023; 17:1125906. [PMID: 37250695 PMCID: PMC10213534 DOI: 10.3389/fnhum.2023.1125906] [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: 12/16/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Despite known health disparities in cognitive aging, a comprehensive rationale for the increased burden in older minoritized populations including non-Latino Black and Latino adults has yet to be elucidated. While most work has focused on person-specific risk, studies are increasingly assessing neighborhood-level risk. We evaluated multiple aspects of the environmental milieu that may be critical when considering vulnerability to adverse health outcomes. Methods We investigated associations between a Census-tract derived Social Vulnerability Index (SVI) and level of and change in cognitive and motor functioning in 780 older adults (590 non-Latino Black adults, ∼73 years old at baseline; 190 Latinos, ∼70 years old baseline). Total SVI scores (higher = greater neighborhood-level vulnerability) were combined with annual evaluations of cognitive and motor functioning (follow-up ranged from 2 to 18 years). Demographically-adjusted mixed linear regression models tested for associations between SVI and cognitive and motor outcomes in analyses stratified by ethno-racial group. Results For non-Latino Black participants, higher SVI scores were associated with lower levels of global cognitive and motor functioning-specifically, episodic memory, motor dexterity and gait-as well as longitudinal change in visuospatial abilities and hand strength. For Latinos, higher SVI scores were associated with lower levels of global motor functioning only-specifically, motor dexterity; there were no significant associations between SVI and change in motor functioning. Discussion Neighborhood-level social vulnerability is associated with cognitive and motor functioning in non-Latino Black and Latino older adults, although associations appear to contribute to level more so than longitudinal change.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - R. Reshmi Mukherjee
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Claremont McKenna College, Claremont, CA, United States
| | - Brittney S. Lange-Maia
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, United States
| | - David X. Marquez
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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29
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Simons R, Ong M, Beach S, Lei MK, Philibert R, Mielke M. Direct and Indirect Effects of Socioeconomic Status and Discrimination on Subjective Cognitive Decline: A Longitudinal Study of African American Women. J Gerontol B Psychol Sci Soc Sci 2023; 78:799-808. [PMID: 36810805 PMCID: PMC10195880 DOI: 10.1093/geronb/gbad029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES The present study builds on recent findings suggesting that the stress of institutional and interpersonal racism may contribute to African Americans' elevated risk for dementia. We investigated the extent to which 2 consequences of racism-low socioeconomic status (SES) and discrimination-predict self-reported cognitive decline (SCD) 19 years later. Further, we examined potential mediating pathways that might link SES and discrimination to cognitive decline. Potential mediators included depression, accelerated biological aging, and onset of chronic illnesses. METHODS Hypotheses were tested using a sample of 293 African American women. SCD was assessed using the Everyday Cognition Scale. Structural equation modeling was used to assess the effects of SES and racial discrimination, both measured in 2002, on SCD reported in 2021. Turning to the mediators, midlife depression was assessed in 2002, accelerated aging in 2019, and chronic illness in 2019. Age and prodrome depression were included as covariates. RESULTS There were direct effects of SES and discrimination on SCD. In addition, these 2 stressors showed a significant indirect effect on SCD through depression. Finally, there was evidence for a more complex pathway where SES and discrimination accelerate biological aging, with accelerated aging, in turn leading to chronic illness, which then predicted SCD. DISCUSSION Results of the present study add to a growing literature indicating that living in a racialized society is a central factor in explaining the high risk for dementia among Black Americans. Future research should continue to emphasize the various ways that exposure to racism over the life course effects cognition.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia,
Athens, Georgia, USA
| | - Mei Ling Ong
- Center for Family Research, University of Georgia,
Athens, Georgia, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia,
Athens, Georgia, USA
| | - Man-Kit Lei
- Department of Sociology, University of Georgia,
Athens, Georgia, USA
| | - Robert Philibert
- Department of Psychiatry, University of Iowa School of
Medicine, Iowa City, Iowa, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University, School
of Medicine, Winston-Salem, North Carolina,
USA
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30
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Fleischman DA, Arfanakis K, Leurgans SE, Zhang S, Lamar M, Han SD, Poole VN, Kim N, Bennett DA, Barnes LL. Late-life depressive symptoms and white matter structural integrity within older Black adults. Front Aging Neurosci 2023; 15:1138568. [PMID: 37205056 PMCID: PMC10186351 DOI: 10.3389/fnagi.2023.1138568] [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: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Older Black adults experience a high burden of depressive symptoms and cerebrovascular disease but the specific neurobiological substrates underlying the association between late-life depressive symptoms and brain integrity are understudied, particularly in within-group designs. Methods Using the Center for Epidemiologic Studies Depression Scale and diffusion-tensor imaging, within-Black variation in the association between late-life depressive symptoms and white matter structural integrity was examined in 297 older Black participants without dementia that were enrolled across three epidemiological studies of aging and dementia. Linear regression models were used to test associations with DTI metrics (fractional anisotropy, trace of the diffusion tensor) as the outcomes and depressive symptoms as the predictor, while adjusting for age, sex, education, scanner, serotonin-reuptake inhibitor use, total volume of white-matter hyperintensities normalized by intracranial volume, and presence of white-matter hyperintensities at the voxel level. Results Higher level of self-reported late-life depressive symptoms was associated with greater diffusion-tensor trace (reduced white matter integrity) in connections between commissural pathways and contralateral prefrontal regions (superior and middle frontal/dorsolateral prefrontal cortex), association pathways connecting dorsolateral prefrontal cortex with insular, striatal and thalamic regions, and association pathways connecting the parietal, temporal and occipital lobes and the thalamus. Discussion This study demonstrated a discernable pattern of compromised white matter structural integrity underlying late-life depressive symptoms within older Black adults.
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Affiliation(s)
- Debra A. Fleischman
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Konstantinos Arfanakis
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, United States
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Preventive Medicine, Rush University Medical Center, Chicago IL, United States
| | - Shengwei Zhang
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - S. Duke Han
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Family Medicine and Neurology, Keck School of Medicine, Los Angeles, CA, United States
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
- School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Victoria N. Poole
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Namhee Kim
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
| | | | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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McDonough IM, Cody SL, Harrell ER, Garrett SL, Popp TE. Cognitive differences across ethnoracial category, socioeconomic status across the Alzheimer's disease spectrum: Can an ability discrepancy score level the playing field? Mem Cognit 2023; 51:543-560. [PMID: 35338450 DOI: 10.3758/s13421-022-01304-3] [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] [Accepted: 03/12/2022] [Indexed: 12/29/2022]
Abstract
An ability discrepancy (crystallized minus fluid abilities) might be a personally relevant cognitive marker of risk for Alzheimer's disease (AD) and might help reduce measurement bias often present in traditional measures of cognition. In a large national sample of adults aged 60-104 years (N = 14,257), we investigated whether the intersectionality of group characteristics previously shown to pose a risk for AD including ethnoracial category, socioeconomic status, and sex (a) differed in ability discrepancy compared to traditional neuropsychological tests and (b) moderated the relationship between an ability discrepancy and AD symptom severity. In cognitively normal older adults, results indicated that across each decade, fluid and memory composite scores generally exhibited large group differences with sex, education, and ethnoracial category. In contrast, the ability discrepancy score showed much smaller group differences, thus removing much of the biases inherent in the tests. Women with higher education differed in discrepancy performance from other groups, suggesting a subgroup in which this score might reduce bias to a lesser extent. Importantly, a greater ability discrepancy was associated with greater AD symptom severity across the AD continuum. Subgroup analyses suggest that this relationship holds for all groups except for some subgroups of Hispanic Americans. These findings suggest that an ability discrepancy measure might be a better indicator of baseline cognition than traditional measures that show more egregious measurement bias across diverse groups of people.
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Affiliation(s)
- Ian M McDonough
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA.
| | - Shameka L Cody
- College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Erin R Harrell
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | | | - Taylor E Popp
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
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Ji L, Zhaoyang R, Jiao J, Schade M, Bertisch S, Derby C, Buxton O, Gamaldo A. Discrimination and Education Quality Moderate the Association of Sleep With Cognitive Function in Older Black Adults: Results From the Einstein Aging Study. J Gerontol B Psychol Sci Soc Sci 2023; 78:596-608. [PMID: 36420651 PMCID: PMC10066742 DOI: 10.1093/geronb/gbac183] [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: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Heterogeneity among Black adults' experiences of discrimination and education quality independently influence cognitive function and sleep, and may also influence the extent to which sleep is related to cognitive function. We investigated the effect of discrimination on the relationship between objective sleep characteristics and cognitive function in older Black adults with varying education quality. METHOD Cross-sectional analyses include Black participants in the Einstein Aging Study (N = 104, mean age = 77.2 years, 21% males). Sleep measures were calculated from wrist actigraphy (15.4 ± 1.3 days). Mean ambulatory cognitive function (i.e., spatial working memory, processing speed/visual attention, and short-term memory binding) was assessed with validated smartphone-based cognitive tests (6 daily). A modified Williams Everyday Discrimination Scale measured discriminatory experiences. Linear regression, stratified by reading literacy (an indicator of education quality), was conducted to investigate whether discrimination moderated associations between sleep and ambulatory cognitive function for individuals with varying reading literacy levels. Models controlled for age, income, sleep-disordered breathing, and sex assigned at birth. RESULTS Higher reading literacy was associated with better cognitive performance. For participants with both lower reading literacy and more discriminatory experiences, longer mean sleep time was associated with slower processing speed, and lower sleep quality was associated with worse working memory. Later sleep midpoint and longer nighttime sleep were associated with worse spatial working memory for participants with low reading literacy, independent of their discriminatory experiences. DISCUSSION Sociocultural factors (i.e., discrimination and education quality) can further explain the association between sleep and cognitive functioning and cognitive impairment risk among older Black adults.
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Affiliation(s)
- Linying Ji
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ruixue Zhaoyang
- Center for Healthy Aging, Pennsylvania State University, University Park, Pennsylvania, USA
| | - June L Jiao
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Margeaux M Schade
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Suzanne Bertisch
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, The Bronx, New York, USA
| | - Orfeu M Buxton
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alyssa A Gamaldo
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
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Kopel J, Sehar U, Choudhury M, Reddy PH. Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in African Americans: Focus on Caregivers. Healthcare (Basel) 2023; 11:healthcare11060868. [PMID: 36981525 PMCID: PMC10048201 DOI: 10.3390/healthcare11060868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Alzheimer’s disease (AD) and Alzheimer’s Disease-Related Dementias (ADRD) are chronic illnesses that are highly prevalent in African Americans (AA). AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Histopathological, morphological, and cellular studies revealed how multiple cellular changes are implicated in AD and ADRD, including synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss, in addition to the accumulation of amyloid beta and phosphorylated tau in the brain. The contributions of race, ethnicity, location and socioeconomic status all have a significant impact on the care and support services available to dementia patients. Furthermore, disparities in health care are entangled with social, economic, and environmental variables that perpetuate disadvantages among different groups, particularly African Americans. As such, it remains important to understand how various racial and ethnic groups perceive, access, and experience health care. Considering that the mounting data shows AA may be more susceptible to AD than white people, the demographic transition creates significant hurdles in providing adequate care from family caregivers. Furthermore, there is growing recognition that AD and ADRD pose a significant stress on AA caregivers compared to white people. In this review, we examine the current literature on racial disparities in AD and ADRD, particularly concerning AA caregivers.
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Affiliation(s)
- Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Moumita Choudhury
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Correspondence: ; Tel.: +1-806-743-3194
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Venkatesan UM, Rabinowitz AR, Bernier RA, Soto JA, Hillary FG. Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:191-200. [PMID: 36731038 DOI: 10.1097/htr.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI). SETTING Outpatient research laboratory. PARTICIPANTS Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI ( N = 118). DESIGN Cross-sectional observational study. MAIN MEASURES MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata ( N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes. RESULTS EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND. CONCLUSION The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.
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Affiliation(s)
- Umesh M Venkatesan
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Drs Venkatesan and Rabinowitz); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Venkatesan and Rabinowitz); Department of Neurosciences, UC San Diego School of Medicine, La Jolla, California (Dr Bernier); Department of Psychology, Pennsylvania State University, University Park (Drs Soto and Hillary); and Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania (Dr Hillary)
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Association of COVID-19-related discrimination with subsequent depression and suicidal ideation in healthcare workers. J Psychiatr Res 2023; 159:153-158. [PMID: 36731380 PMCID: PMC9849914 DOI: 10.1016/j.jpsychires.2023.01.025] [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] [Received: 10/26/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023]
Abstract
Previous cross-sectional studies showed that COVID-19-related discrimination against healthcare workers was linked to depression. However, no study has examined the longitudinal association that allows causal interpretations. This prospective cohort study aimed to examine whether COVID-19-related discrimination at baseline is associated with depression and suicidal ideation several months later. Data were collected from October 2020 to July 2021. Multivariable logistic regression was performed. Fixed effects models were used to control for the effect of hospitals (Level 2 variable). Adjustments also included age, sex, living alone, alcohol consumption, exercise, BMI, working hours, comorbidity, and frontline worker status (Level 1 variables). Multiple sensitivity analyses were conducted to examine if the results substantially changed and were robust to unmeasured confounding. Multiple imputation for missing data was conducted via chained equations. As the final sample, 2862 healthcare workers without depression at baseline were studied. A total of 269 individuals (9.4%) experienced COVID-19-related discrimination. Depression was suggested in 205 participants (7.2%), and suicidal ideation in 108 participants (3.8%). In the adjusted models, COVID-19-related discrimination was significantly associated with subsequent depression (OR = 2.18, 95% CI = 1.39 to 2.90) and suicidal ideation (OR = 2.07, 95% CI = 1.22 to 3.50). Multiple sensitivity analyses verified the results. COVID-19-related discrimination results in depression and suicidal ideation in healthcare workers. Interventions to prevent such discrimination against healthcare workers, e.g., anti-discrimination campaigns, are crucial during the COVID-19 pandemic.
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Bloom RF, Siedlecki KL. Testing the Reserve Capacity Model: Does Race Moderate the Relationship Between Negative Emotions and Neurocognition? Arch Clin Neuropsychol 2023; 38:213-223. [PMID: 36062422 PMCID: PMC9940113 DOI: 10.1093/arclin/acac070] [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: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To test whether race moderates the relationship between negative emotions and neurocognition by applying the reserve capacity model within a large sample that spans adulthood. METHOD The study sample (N = 1,020) consisted of community-dwelling adults between 18 and 84 years of age who were drawn from the Virginia Cognitive Aging Project. Demographic variables were used to match a sample of Black participants to a sample of White participants. Race was examined as a moderator of the relationship between negative emotions (i.e., depressive symptoms, trait anxiety, and the negative affect subscale from the Positive and Negative Affect Schedule) and neurocognitive variables (episodic memory, reasoning, spatial visualization, and processing speed) with multiple-group structural equation modeling. RESULTS After accounting for sociodemographic variables, depressive symptoms were negatively associated with processing speed in both groups, and with worse reasoning in the White subsample. Negative affect was associated with lower reasoning performance in both groups and with lower spatial visualization in the White subsample. Trait anxiety was not significantly associated with the neurocognitive constructs in either group. Multigroup structural equation models showed that the magnitudes of the associations were not different between the Black and White subsamples. Thus, race did not moderate the relationships between depressive symptoms, trait anxiety, and negative affect with neurocognition. CONCLUSIONS Negative emotions are associated with lower performance on different neurocognitive tasks, but race does not moderate these relationships. Future research should examine perceived discrimination or other psychosocial variables when examining the relationships among negative emotions and neurocognition.
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Affiliation(s)
- Rachel F Bloom
- Department of Psychology, Fordham University, Bronx, NY10458, USA
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Dambrun M, Bonetto E, Motak L, Baker JS, Bagheri R, Saadaoui F, Rabbouch H, Zak M, Nasir H, Mermillod M, Gao Y, Antunes S, Ugbolue UC, Pereira B, Bouillon-Minois JB, Nugier A, Clinchamps M, Dutheil F. Perceived discrimination based on the symptoms of covid-19, mental health, and emotional responses-the international online COVISTRESS survey. PLoS One 2023; 18:e0279180. [PMID: 36598901 PMCID: PMC9812319 DOI: 10.1371/journal.pone.0279180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the potential detrimental consequences for individuals' health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness. METHODS The study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health. RESULTS The results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant. DISCUSSION This study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.
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Affiliation(s)
- Michaël Dambrun
- Université Clermont Auvergne, CNRS, LaPSCo, F-63000, Clermont-Ferrand, France
- * E-mail:
| | - Eric Bonetto
- Aix-Marseille University, Aix-en-Provence, France
| | - Ladislav Motak
- Université Clermont Auvergne, CNRS, LaPSCo, F-63000, Clermont-Ferrand, France
| | - Julien S. Baker
- Hong Kong Baptist University, Sport, Physical Education and Health, Kowloon Tong, Hong Kong
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Foued Saadaoui
- Faculty of Sciences, Statistics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hana Rabbouch
- Institut Supérieur de Gestion de Tunis, Université de Tunis, Tunis, Tunisia
| | - Marek Zak
- Institute of Health Sciences, The Jan Kochanowski University of Kielce, Collegium Medicum, Kielce, Poland
| | - Hijrah Nasir
- Université Clermont Auvergne, Economic Development, Clermont-Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Yang Gao
- Hong Kong Baptist University, Sport, Physical Education and Health, Kowloon Tong, Hong Kong
| | - Samuel Antunes
- ISPA—Instituto Universitário, Ordem dos Psicólogos Portugueses, APPsyCI—Applied Psychology Research Center Capabilities & Inclusion, Lisboa, Portugal
| | - Ukadike Chris Ugbolue
- Institute for Clinical Exercise & Health Science, University of the West of Scotland, School of Health and Life Sciences, South Lanarkshire, Scotland, United Kingdom
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics, Clermont-Ferrand, France
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, WittyFit, Clermont-Ferrand, France
| | - Armelle Nugier
- Université Clermont Auvergne, CNRS, LaPSCo, F-63000, Clermont-Ferrand, France
| | - Maëlys Clinchamps
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, WittyFit, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, WittyFit, Clermont-Ferrand, France
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Zahodne LB, Sharifian N, Kraal AZ, Morris EP, Sol K, Zaheed AB, Meister L, Mayeux R, Schupf N, Manly JJ, Brickman AM. Longitudinal associations between racial discrimination and hippocampal and white matter hyperintensity volumes among older Black adults. Soc Sci Med 2023; 316:114789. [PMID: 35164975 PMCID: PMC9579996 DOI: 10.1016/j.socscimed.2022.114789] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/17/2022] [Accepted: 02/04/2022] [Indexed: 02/09/2023]
Abstract
RATIONALE Non-Hispanic Black older adults are at higher risk of Alzheimer's disease and related dementias (ADRD) than non-Hispanic Whites, which reflects racial disparities in both brain and cognitive health. Discrimination may contribute to these disparities, but much of the research on discrimination and ADRD outcomes is cross-sectional and/or does not disaggregate experiences of discrimination by attribution. Focusing specifically on racial discrimination and considering longitudinal brain outcomes may advance our understanding of the role of discrimination in explaining disproportionate rates of ADRD among non-Hispanic Black older adults. METHODS In total, 221 non-Hispanic Black participants in the Washington Heights-Inwood Columbia Aging Project completed multiple measures of discrimination at one time point and structural magnetic resonance imaging (MRI) scans at two time points. Everyday discrimination and lifetime discrimination were operationalized first as aggregate experiences of discrimination (regardless of identity attributions) and then as racial discrimination per se. MRI outcomes included hippocampal and white matter hyperintensity (WMH) volumes. Latent difference score models estimated associations between the discrimination measures and each MRI outcome over four years. RESULTS Aggregate discrimination (regardless of attributions) was not associated with either outcome. Lifetime racial discrimination was associated with lower initial hippocampal volume. Everyday racial discrimination was associated with faster accumulation of WMH over time. CONCLUSIONS Racial discrimination may be detrimental for brain aging among non-Hispanic Black older adults, which may contribute to their disproportionate dementia burden. Disaggregating discrimination by attribution may clarify research on racial inequalities in brain and cognitive aging, as racial discrimination appears to be particularly toxic.
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Affiliation(s)
- Laura B Zahodne
- Department of Psychology, University of Michigan, United States.
| | - Neika Sharifian
- Department of Psychology, University of Michigan, United States
| | - A Zarina Kraal
- Department of Psychology, University of Michigan, United States
| | - Emily P Morris
- Department of Psychology, University of Michigan, United States
| | - Ketlyne Sol
- Department of Psychology, University of Michigan, United States
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, United States
| | - Lindsey Meister
- Department of Psychology, University of Michigan, United States
| | - Richard Mayeux
- Department of Neurology, Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, United States
| | - Nicole Schupf
- Department of Neurology, Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, United States
| | - Jennifer J Manly
- Department of Neurology, Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, United States
| | - Adam M Brickman
- Department of Neurology, Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, United States
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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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Turney IC, Lao PJ, Rentería MA, Igwe KC, Berroa J, Rivera A, Benavides A, Morales CD, Rizvi B, Schupf N, Mayeux R, Manly JJ, Brickman AM. Brain Aging Among Racially and Ethnically Diverse Middle-Aged and Older Adults. JAMA Neurol 2023; 80:73-81. [PMID: 36374494 PMCID: PMC9664371 DOI: 10.1001/jamaneurol.2022.3919] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
Abstract
Importance Neuroimaging studies have documented racial and ethnic disparities in brain health in old age. It remains unclear whether these disparities are apparent in midlife. Objective To assess racial and ethnic disparities in magnetic resonance imaging (MRI) markers of cerebrovascular disease and neurodegeneration in midlife and late life. Design, Setting, and Participants Data from 2 community-based cohort studies, Washington Heights-Inwood Columbia Aging Project (WHICAP) and the Offspring Study of Racial and Ethnic Disparities in Alzheimer Disease (Offspring), were used. Enrollment took place from March 2011 and June 2017, in WHICAP and Offspring, respectively, to January 2021. Of the 822 Offspring and 1254 WHICAP participants approached for MRI scanning, 285 and 176 refused participation in MRI scanning, 36 and 76 were excluded for contraindications/ineligibility, and 4 and 32 were excluded for missing key variables, respectively. Main Outcomes and Measures Cortical thickness in Alzheimer disease-related regions, white matter hyperintensity (WMH) volume. Results The final sample included 1467 participants. Offspring participants (497 [33.9%]) had a mean (SD) age of 55 (10.7) years, had a mean (SD) of 13 (3.5) years of education, and included 117 Black individuals (23.5%), 348 Latinx individuals (70%), 32 White individuals (6.4%), and 324 women (65.2%). WHICAP participants (970 [66.1%]) had a mean (SD) age of 75 (6.5) years, had a mean (SD) of 12 (4.7) years of education, and included 338 Black individuals (34.8%), 389 Latinx individuals (40.1%), 243 White individuals (25.1%), and 589 women (65.2%). Racial and ethnic disparities in cerebrovascular disease were observed in both midlife (Black-White: B = 0.357; 95% CI, 0.708-0.007; P = .046) and late life (Black-Latinx: B = 0.149, 95% CI, 0.068-0.231; P < .001; Black-White: B = 0.166; 95% CI, 0.254-0.077; P < .001), while disparities in cortical thickness were evident in late life only (Black-Latinx: B = -0.037; 95% CI, -0.055 to -0.019; P < .001; Black-White: B = -0.064; 95% CI -0.044 to -0.084; P < .001). Overall, Black-White disparities were larger than Latinx-White disparities for cortical thickness and WMH volume. Brain aging, or the association of age with MRI measures, was greater in late life compared with midlife for Latinx (cortical thickness: B = 0.006; 95% CI, 0.004-0.008; P < .001; WMH volume: B = -0.010; 95% CI, -0.018 to -0.001; P = .03) and White (cortical thickness: B = 0.005; 95% CI, 0.002-0.008; P = .001; WMH volume: B = -0.021; 95% CI -0.043 to 0.002; P = .07) participants but not Black participants (cortical thickness: B = 0.001; 95% CI, -0.002 to 0.004; P =.64; WMH volume: B = 0.003; 95% CI, -0.010 to 0.017; P = .61), who evidenced a similarly strong association between age and MRI measures in midlife and late life. Conclusions and Relevance In this study, racial and ethnic disparities in small vessel cerebrovascular disease were apparent in midlife. In Latinx and White adults, brain aging was more pronounced in late life than midlife, whereas Black adults showed accelerated pattern of brain aging beginning in midlife.
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Affiliation(s)
- Indira C. Turney
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Patrick J. Lao
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kay C. Igwe
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joncarlos Berroa
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Andres Rivera
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Andrea Benavides
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Clarissa D. Morales
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Batool Rizvi
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
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Mindt MR, Ashford MT, Zhu D, Cham H, Aaronson A, Conti C, Deng X, Alaniz R, Sorce J, Cypress C, Griffin P, Flenniken D, Camacho M, Fockler J, Truran D, Mackin RS, Hill C, Weiner MW, Byrd D, Turner Ii RW, Nosheny RL. The Community Engaged Digital Alzheimer's Research (CEDAR) Study: A Digital Intervention to Increase Research Participation of Black American Participants in the Brain Health Registry. J Prev Alzheimers Dis 2023; 10:847-856. [PMID: 37874107 PMCID: PMC10598330 DOI: 10.14283/jpad.2023.32] [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] [Indexed: 10/25/2023]
Abstract
BACKGROUND Although Black/African American older adults bear significant inequities in prevalence, incidence, and outcomes of Alzheimer's disease and related dementias, they are profoundly under-included in Alzheimer's Disease research. Community-Engaged Research (e.g., equitable community/science partnerships) is an evidence-based approach for improving engagement of underrepresented populations into Alzheimer's Disease research, but has lacked scalability to the national level. As internet use among older adults from underrepresented populations continues to grow, internet-based research shows promise as a feasible, valid approach to engagement and longitudinal assessment. The Community Engaged Digital Alzheimer's Research (CEDAR) study utilizes a community-engaged research approach to increase the engagement and research participation of Black/African American adults in the Brain Health Registry (BHR) and Alzheimer Disease clinical research. OBJECTIVES To describe the methods and evaluate the feasibility of the CEDAR culturally-informed digital platform within BHR. DESIGN All Black/African American participants in BHR were invited to enroll in CEDAR and to consider serving on a newly convened Community-Scientific Partnership Board to guide the study. The community board guided the development a culturally-informed cadre of engagement materials and strategies to increase research participation. Engagement strategies included incentives for study task completion, culturally-informed communications (e.g., landing page, emails and social media), resources about brain health, and video and written testimonials by CEDAR participants. SETTING BHR, an Internet-based registry and cohort. PARTICIPANTS BHR participants self-identifying as Black/African American were invited to enroll. All participants who signed an online informed consent document were enrolled. MEASUREMENTS We report the number of participants invited, enrolled, completed tasks, and volunteered to join the community board. We compared the demographics, cognitive profile, and baseline BHR task completion rates between CEDAR participants and all those invited to join the study. RESULTS Of 3738 invited, 349 (9.34%) enrolled in CEDAR. 134 (37% of CEDAR participants) volunteered to join the community board, of which 19 were selected for the community board. Compared to those invited, the CEDAR cohort had a higher percentage of female participants (84.5%) and a lower percentage of participants who identify as belonging to more than one ethnocultural group (21.8%). Compared to those did not enroll in CEDAR, those enrolled in CEDAR had a higher percentage of participants completing all BHR tasks (22%) and a higher percentage of participants completing at least one cognitive test (76%). Those enrolled in CEDAR also had a higher percentage of participants having an enrolled study partner (18%). CONCLUSIONS A culturally-informed Community-Engaged Research approach, including a remotely-convened community board, to engagement of Black/African American participants in an online research registry is feasible. This approach can be adapted for use in various clinical studies and other settings. Future studies will evaluate the effectiveness of the engagement strategies.
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Affiliation(s)
- M R Mindt
- Rachel Nosheny, 4150 Clement Street, 114M, San Francisco, CA. 94121, USA, Telephone: 415-221-4810, Email address: Fax number: 415-221-4810
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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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Lusk JB, Ford C, Clark AG, Greiner MA, Johnson K, Goetz M, Kaufman BG, Mantri S, Xian Y, O'Brien R, O'Brien EC. Racial/ethnic disparities in dementia incidence, outcomes, and health‐care utilization. Alzheimers Dement 2022. [DOI: 10.1002/alz.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Jay B. Lusk
- Duke University School of Medicine Durham North Carolina USA
- Duke University Fuqua School of Business Durham North Carolina USA
| | - Cassie Ford
- Department of Population Health Sciences Duke University Durham North Carolina USA
| | - Amy G. Clark
- Department of Population Health Sciences Duke University Durham North Carolina USA
| | - Melissa A. Greiner
- Department of Population Health Sciences Duke University Durham North Carolina USA
| | - Kim Johnson
- Department of Neurology Duke University Durham North Carolina USA
- Department of Psychiatry and Behavioral Sciences Duke University Duke University Medical Center Durham North Carolina USA
| | - Margarethe Goetz
- Department of Neurology Duke University Durham North Carolina USA
| | - Brystana G. Kaufman
- Department of Population Health Sciences Duke University Durham North Carolina USA
| | - Sneha Mantri
- Department of Neurology Duke University Durham North Carolina USA
| | - Ying Xian
- Department of Neurology University of Texas‐Southwestern Dallas Texas USA
- Department of Population and Data Sciences University of Texas‐Southwestern Dallas Texas USA
| | - Richard O'Brien
- Department of Neurology Duke University Durham North Carolina USA
| | - Emily C. O'Brien
- Department of Population Health Sciences Duke University Durham North Carolina USA
- Department of Neurology Duke University Durham North Carolina USA
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Chen R, Williams DR, Nishimi K, Slopen N, Kubzansky LD, Weuve J. A life course approach to understanding stress exposures and cognitive function among middle-aged and older adults. Soc Sci Med 2022; 314:115448. [PMID: 36274453 PMCID: PMC10069937 DOI: 10.1016/j.socscimed.2022.115448] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 08/28/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many studies have evaluated the stress-cognition association, but few have captured the cumulative nature of stress or distinguished the influences of stressors occurring in childhood versus adulthood. Using a lifecourse approach, we investigated whether cumulative stress exposures are associated with poorer cognitive function and faster cognitive decline. METHODS We used data from the Midlife Development in the United States Study (N = 3,954, mean baseline age: 56 years). We fit marginal structural generalized estimating equations models to estimate the difference in baseline cognitive function per SD increment in the continuous stressor score, and, separately, between persons in each life course stressor profile and those who did not experience high stress in either childhood or adulthood. We also characterized differences in cognitive decline across levels of stress exposures. RESULTS Higher cumulative stress exposure was associated with lower executive function (difference per SD in continuous stressor score = -0.12 SD units, 95% CI = -0.16, -0.08) and episodic memory (difference = -0.09 SD units, 95% CI = -0.13, -0.05). Baseline executive function and episodic memory were lower among those with high stress only in childhood, only in adulthood, and both, than among those without high stress in childhood or adulthood. There was little evidence that rate of change in executive function and episodic memory differed across levels of cumulative stress exposures. CONCLUSIONS These findings offer support to the hypothesis that stress exposures, accumulated over the life course, worsen cognitive performance, but limited support for the hypothesis that these exposures promote cognitive decline.
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Affiliation(s)
- Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Kristen Nishimi
- Department of Psychiatry, University of California, San Francisco, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, USA
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Hromas G, Rolin S, Davis JJ. Racial differences in positive findings on embedded performance validity tests. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36416227 PMCID: PMC10203055 DOI: 10.1080/23279095.2022.2146504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Embedded performance validity tests (PVTs) may show increased positive findings in racially diverse examinees. This study examined positive findings in an older adult sample of African American (AA) and European American (EA) individuals recruited as part of a study on aging and cognition. METHOD The project involved secondary analysis of deidentified National Alzheimer's Coordinating Center data (N = 22,688). Exclusion criteria included diagnosis of dementia (n = 5,550), mild cognitive impairment (MCI; n = 5,160), impaired but not MCI (n = 1,126), other race (n = 864), and abnormal Mini Mental State Examination (MMSE < 25; n = 135). The initial sample included 9,853 participants (16.4% AA). Propensity score matching matched AA and EA participants on age, education, sex, and MMSE score. The final sample included 3,024 individuals with 50% of participants identifying as AA. Premorbid ability estimates were calculated based on demographics. Failure rates on five raw score and six age-adjusted scaled score PVTs were examined by race. RESULTS Age, education, sex, MMSE, and premorbid ability estimate were not significantly different by race. Thirteen percent of AA and 3.8% of EA participants failed two or more raw score PVTs (p < .0001). On age-adjusted PVTs, 20.6% of AA and 5.9% of EA participants failed two or more (p < .0001). CONCLUSIONS PVT failure rates were significantly higher among AA participants. Findings indicate a need for cautious interpretation of embedded PVTs with underrepresented groups. Adjustments to embedded PVT cutoffs may need to be considered to improve diagnostic accuracy.
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Affiliation(s)
- Gabrielle Hromas
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Summer Rolin
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jeremy J Davis
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Hamler TC, Nguyen AW, Keith V, Qin W, Wang F. How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans. J Gerontol B Psychol Sci Soc Sci 2022; 77:2026-2037. [PMID: 35976084 PMCID: PMC9683503 DOI: 10.1093/geronb/gbac115] [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: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans. METHODS Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims. RESULTS Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women. DISCUSSION This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the "why" is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.
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Affiliation(s)
- Tyrone C Hamler
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Verna Keith
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Weidi Qin
- Center for Social Epidemiology and Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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Han SD, Fleischman DA, Yu L, Poole V, Lamar M, Kim N, Leurgans SE, Bennett DA, Arfanakis K, Barnes LL. Cognitive decline and hippocampal functional connectivity within older Black adults. Hum Brain Mapp 2022; 43:5044-5052. [PMID: 36066181 PMCID: PMC9582363 DOI: 10.1002/hbm.26070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/26/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
While there has been a proliferation of neuroimaging studies on cognitive decline in older non-Hispanic White adults, there is a dearth of knowledge regarding neuroimaging correlates of cognitive decline in Black adults. Resting-state functional neuroimaging approaches may be particularly sensitive to early cognitive decline, but there are no studies that we know of that apply this approach to examining associations of brain function to cognition in older Black adults. We investigated the association of cognitive decline with whole-brain voxel-wise functional connectivity to the hippocampus, a key brain region functionally implicated in early Alzheimer's dementia, in 132 older Black adults without dementia participating in the Minority Aging Research Study and Rush Memory and Aging Project, two longitudinal studies of aging that include harmonized annual cognitive assessments and magnetic resonance imaging brain imaging. In models adjusted for demographic factors (age, education, sex), global cognitive decline was associated with functional connectivity of the hippocampus to three clusters in the right and left frontal regions of the dorsolateral prefrontal cortex. In domain-specific analyses, decline in semantic memory was associated with functional connectivity of the hippocampus to bilateral clusters in the precentral gyrus, and decline in perceptual speed was inversely associated with connectivity of the hippocampus to the bilateral intracalcarine cortex and the right fusiform gyrus. These findings elucidate neurobiological mechanisms underlying cognitive decline in older Black adults and may point to specific targets of intervention for Alzheimer's disease.
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Affiliation(s)
- S. Duke Han
- Department of Family MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of NeurologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Debra A. Fleischman
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Lei Yu
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Victoria Poole
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Melissa Lamar
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Namhee Kim
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Sue E. Leurgans
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Biomedical EngineeringIllinois Institute of TechnologyChicagoIllinoisUSA
- Department of Diagnostic Radiology and Nuclear MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Lisa L. Barnes
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
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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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Wilkins CH, Windon CC, Dilworth-Anderson P, Romanoff J, Gatsonis C, Hanna L, Apgar C, Gareen IF, Hill CV, Hillner BE, March A, Siegel BA, Whitmer RA, Carrillo MC, Rabinovici GD. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) Cohort Study. JAMA Neurol 2022; 79:2796653. [PMID: 36190710 PMCID: PMC9531087 DOI: 10.1001/jamaneurol.2022.3157] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023]
Abstract
Importance Racial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET). Objective To compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia. Design, Setting, and Participants Secondary analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups. Exposures In the IDEAS study, participants underwent a single amyloid PET scan. Main Outcomes and Measures The main outcomes were amyloid PET positivity proportions and odds. Results Data from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P < .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P < .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P < .001) compared with White participants. Conclusions and Relevance Racial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.
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Affiliation(s)
- Consuelo H. Wilkins
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles C. Windon
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | - Andrew March
- Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente, Oakland, California
- Department of Public Health Sciences, University of California, Davis
| | | | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
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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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