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Shin SH, Walker SL, Ji H, Lee HY. Performance Under Fire: Older Adult Cognitive Risks and Protections Under Heat Strain. THE GERONTOLOGIST 2024; 64:gnae116. [PMID: 39166357 PMCID: PMC11467403 DOI: 10.1093/geront/gnae116] [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: 02/12/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although extreme heat events disproportionately affect older adults and the importance of cognition is known, research examining older adult cognition under heat stress is limited. This study examines the relationship between risk/protective factors and heat strain on older adult cognition, employing a social-ecological model. RESEARCH DESIGN AND METHODS Retrieved from the 1996-2016 waves of the Health and Retirement Study, our study used older adults aged 50 and older and their spouses residing in the United States. Individual-fixed effects models estimated changes in cognition as measured by fluid and crystallized intelligence scores in response to extreme heat days. This study further estimated interactions of extreme heat with protective/risk factors for cognition (i.e., education, physical activity, social engagement, and genetic risk for Alzheimer's disease). RESULTS Our results demonstrated that extreme heat days were associated with fluid but not crystallized intelligence scores. Educational attainment, mild physical activity, and social contacts with children moderated this relationship. Furthermore, Alzheimer's disease polygenic scores moderated the correlation between extreme heat days and crystallized intelligence scores. DISCUSSION AND IMPLICATIONS An increasing frequency of extreme heat events and an aging population globally highlight the need for policies and interventions building resiliency in older adults. Actions promoting the protective modifiable behaviors to older adult cognition identified by our study can lead to healthier individuals and communities.
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Affiliation(s)
- Su Hyun Shin
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah, USA
| | - Susan Lee Walker
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah, USA
| | - Hyunjung Ji
- Department of Political Science, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
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Rivera Mindt M, Arentoft A, Calcetas AT, Guzman VA, Amaza H, Ajayi A, Ashford MT, Ayo O, Barnes LL, Camuy A, Conti C, Diaz A, Easter B, Gonzalez DJ, Dotson YG, Hoang I, Germano KK, Maestre GE, Magaña F, Meyer OL, Miller MJ, Nosheny R, Park VMT, Parkins S, Thomas LR, Strong J, Talavera S, Verney SP, Weisensel T, Weiner MW, Okonkwo OC. The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) Engagement Core: A culturally informed, community-engaged research (CI-CER) model to advance brain health equity. Alzheimers Dement 2024. [PMID: 39440702 DOI: 10.1002/alz.14242] [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: 05/02/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 10/25/2024]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) Engagement Core was launched to advance Alzheimer's disease (AD) and AD-related dementia (ADRD) health equity research in underrepresented populations (URPs). We describe our evidence-based, scalable culturally informed, community-engaged research (CI-CER) model and demonstrate its preliminary success in increasing URP enrollment. METHODS URPs include ethnoculturally minoritized, lower education (≤ 12 years), and rural populations. The CI-CER model includes: (1) culturally informed methodology (e.g., less restrictive inclusion/exclusion criteria, sociocultural measures, financial compensation, results disclosure, Spanish Language Capacity Workgroup) and (2) inclusive engagement methods (e.g., the Engagement Core team; Hub Sites; Community-Science Partnership Board). RESULTS As of April 2024, 60% of ADNI-4 new in-clinic enrollees were from ethnoculturally or educationally URPs. This exceeds ADNI-4's ≥ 50% URP representation goal for new enrollees but may not represent final enrollment. DISCUSSION Findings show a CI-CER model increases URP enrollment in AD/ADRD clinical research and has important implications for clinical trials to advance health equity. HIGHLIGHTS The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) uses a culturally informed, community-engaged research (CI-CER) approach. The CI-CER approach is scalable and sustainable for broad, multisite implementation. ADNI-4 is currently exceeding its inclusion goals for underrepresented populations.
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Affiliation(s)
- Mónica Rivera Mindt
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Latin American and Latino Studies Institute and Department of African and African American Studies, Fordham University, Bronx, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alyssa Arentoft
- Department of Psychology, California State University, Northridge, Northridge, California, USA
| | | | - Vanessa A Guzman
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannatu Amaza
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Adeyinka Ajayi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Miriam T Ashford
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
- VA Advanced Imaging Research Center, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Omobolanle Ayo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
| | - Alicia Camuy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Conti
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
- VA Advanced Imaging Research Center, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Adam Diaz
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
- VA Advanced Imaging Research Center, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Bashir Easter
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
- Melanin Minded LLC, Milwaukee, Wisconsin, USA
| | - David J Gonzalez
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
| | - Yolanda Graham Dotson
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
- Indiana Alzheimer's Disease Research Center, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Isabella Hoang
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Gladys E Maestre
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
- Department of Neuroscience, University of Texas Rio Grande Valley School of Medicine, Rancho Viejo, Texas, USA
| | - Fabiola Magaña
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Oanh L Meyer
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
- Department of Neurology, School of Medicine, University of California Davis, Sacramento, California, USA
| | - Melanie J Miller
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
- VA Advanced Imaging Research Center, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Rachel Nosheny
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
- VA Advanced Imaging Research Center, Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Van M Ta Park
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
- Asian American Research Center on Health (ARCH), University of California San Francisco, San Francisco, California, USA
| | - Shaniya Parkins
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa Renier Thomas
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joe Strong
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sandra Talavera
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
| | - Steven P Verney
- Community Science Partnership Board (CSPB), Alzheimer's Disease Neuroimaging Initiative, New York, New York, USA
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Trinity Weisensel
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael W Weiner
- Northern California Institute for Research and Education (NCIRE), San Francisco, California, USA
- VA Advanced Imaging Research Center, Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Ozioma C Okonkwo
- Department of Medicine, Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Moorman SM, Kong J. High School Curricular Rigor and Cognitive Function among White Older Adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241283745. [PMID: 39436981 DOI: 10.1177/00221465241283745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
Most research on the strong relationship between education and cognitive aging has focused on years of schooling. Using data from the Wisconsin Longitudinal Study-a sample of White persons born in 1939-we explored whether greater curricular rigor in high school was also associated with better cognitive function in later life. We estimated multilevel structural equation models in data from 2,749 participants who attended 308 Wisconsin high schools, graduating in 1957. Independent of academic ability and performance and school-level financial and material resources, a more rigorous high school curriculum was associated with significantly better global cognitive functioning in 2020, when most participants were 81 years old. There was also a significant mediation via eventual degree attainment. The mediation was moderated such that men and participants from high socioeconomic status families benefited most from a rigorous curriculum. We discuss implications for modern educational policy.
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Rosenqvist J, Slama S, Haavisto A. The FinSwed study: Using verbal NEPSY-II subtests with a cultural minority group. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-11. [PMID: 39392443 DOI: 10.1080/21622965.2024.2406921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
While it has been established that cultural differences in test performance are common, few studies have compared groups from different countries that speak the same language. The aim of this study was to investigate the generalizability of selected linguistic and verbal memory subtests from the Swedish NEPSY-II to the Finland-Swedish minority group. The participants were 275 Swedish-speaking children from Finland aged 5-16-years. The performance was compared to the U.S. norms used in the test. The Finland-Swedish children scored around scaled score 12 and significantly higher than the normative mean on the subtests Comprehension of Instructions, Phonological Processing, Word Generation Semantic, List Memory, and Sentence Repetition, whereas no significant differences to the norms emerged for the subtests Word Generation Initial Letter, Narrative Memory, and Word List Interference. There was a significant age effect for two subtests, with scaled scores increasing with age. Lower parental education and male sex were associated with lower test scores on some subtests, whereas bilingualism was not. The findings were viewed in relation to previous comparison studies involving the NEPSY-II/NEPSY. The differences were suggested to relate to cultural, educational, and test-related differences between Finland, Sweden, and the U.S. The results add to the clinical utility of the NEPSY-II.
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Affiliation(s)
- Johanna Rosenqvist
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Slama
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu Haavisto
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Faculty of Education and Welfare Studies, Åbo Akademi University, Turku, Finland
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Gutierrez S, Whitmer RA, Soh Y, Peterson R, George KM, Lor Y, Barnes LL, Mayeda ER, Allen IE, Torres JM, Glymour MM, Gilsanz P. School-based racial segregation, social support, and late-life cognitive function in the Study of Healthy Aging in African Americans (STAR). Alzheimers Dement 2024; 20:6257-6267. [PMID: 39054568 PMCID: PMC11497676 DOI: 10.1002/alz.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION School-based social support for Black students may mediate or modify the association between school segregation and late-life cognition. METHODS Study of Healthy Aging in African Americans participants (n = 574) reported segregated school attendance and school-based social support. Associations of segregated schooling with domain-specific cognitive outcomes and effect modification or mediation by school-based social support were evaluated with linear mixed models. RESULTS Segregated school attendance was associated with increased likelihood of school-based social support. Segregated (vs. desegregated in 6th grade) school attendance was associated with lower executive function (β = -0.18 [-0.34, -0.02]) and semantic memory z-scores (β = -0.31 [-0.48, -0.13]). Social support did not mediate these associations. Estimates for segregated school attendance were attenuated among those who felt supported, although there was limited evidence of statistically significant effect modification. DISCUSSION Early-childhood school segregation was associated with poorer cognitive function. Sources of resilience within racialized educational experiences should be further evaluated to bridge inequities. HIGHLIGHTS School segregation is a form of structural racism that affected the educational experiences of Black youth with potentially lasting consequences for healthy brain aging. Black students who attended a segregated school experienced greater school-based social support, which may highlight a potential source of resilience and resistance against the effects of racism-related stressors on cognitive function. The estimated adverse association between attending a segregated school on cognition was larger for students without an adult at school who cared about them versus those with an adult at school who cared about them, but estimates were imprecise.
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Affiliation(s)
- Sirena Gutierrez
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Rachel A. Whitmer
- Alzheimer's Disease CenterUniversity of California, DavisSacramentoCaliforniaUSA
- Department of Public Health SciencesUniversity of California, Davis, Medical Sciences 1‐CDavisCaliforniaUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Yenee Soh
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Rachel Peterson
- School of Public and Community Health SciencesUniversity of MontanaMissoulaMontanaUSA
| | - Kristen M. George
- Department of Public Health SciencesUniversity of California, Davis, Medical Sciences 1‐CDavisCaliforniaUSA
| | - Yi Lor
- Department of Public Health SciencesUniversity of California, Davis, Medical Sciences 1‐CDavisCaliforniaUSA
| | - Lisa L. Barnes
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Elizabeth Rose Mayeda
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Isabel E. Allen
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Jacqueline M. Torres
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - M. Maria Glymour
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Paola Gilsanz
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
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Troxel WM, Dubowitz T, Haas A, Ghosh-Dastidar B, Butters MA, Gary-Webb TL, Weinstein AM, Ibeanu A, Wagner L, Gildengers A, Rosso AL. A Preliminary Analysis of Stress Burden and Cognitive Function and Clinically Adjudicated Cognitive Outcomes in Black American Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glae177. [PMID: 39021075 PMCID: PMC11329620 DOI: 10.1093/gerona/glae177] [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: 02/21/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, "stress burden") on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator. METHODS The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension. RESULTS Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes. CONCLUSIONS Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities.
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Affiliation(s)
- Wendy M Troxel
- Division of Social and Economic Well-Being, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Tamara Dubowitz
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ann Haas
- Division of Social and Economic Well-Being, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Bonnie Ghosh-Dastidar
- Division of Economics and Sociology, RAND Corporation, Santa Monica, California, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea M Weinstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ada Ibeanu
- Division of Social and Economic Well-Being, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | | | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ping Y, Odden MC, Chen X, Prina M, Xu H, Xiang H, Wu C. A Polysocial Approach in Exploring Racial and Ethnic Differences in Dementia and Cognitive Decline Among U.S. Older Adults: Health and Retirement Study. Innov Aging 2024; 8:igae078. [PMID: 39416701 PMCID: PMC11481015 DOI: 10.1093/geroni/igae078] [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: 12/22/2023] [Indexed: 10/19/2024] Open
Abstract
Background and Objectives The racial or ethnic disparity in the burden of dementia exists among older adults in the United States, whereas gaps remain in understanding the synergic effect of multiple social determinants of health on diminishing this disparity. We aim to build a polysocial score for dementia and investigate the racial or ethnic difference in dementia risk among older persons with different polysocial score categories. Research Design and Methods In this prospective cohort study, we utilized longitudinal data from the Health and Retirement Study in the United States recruiting 6 945 participants aged ≥65 years who had data on 24 social determinants of health in 2006/2008. The dementia status of participants was measured by a modified version of the Telephone Interview of Cognitive Status. The stepwise Cox regression was applied to select social determinants of health associated with incident dementia to construct a polysocial score. The multivariable Poisson model and linear mixed model were utilized to investigate the associations between polysocial score and incident dementia and cognitive decline, respectively. Results Eight social determinants of health were used to build the polysocial score. Non-Hispanic Black older participants had a higher incidence rate (incidence rate difference [IRD] = 22.7; 95% confident interval [95% CI] = 12.7-32.8) than non-Hispanic White older adults in the low polysocial score, while this difference was substantially attenuated in the high polysocial score category (IRD = 0.5; 95% CI = -6.4 to -7.5). The cognitive decline of non-Hispanic older Black adults with high polysocial score was 84.6% slower (averaged cognitive decline: non-Hispanic White: -2.4 [95% CI = -2.5 to -2.3] vs non-Hispanic Black: -1.3 [95% CI = -1.9 to -0.8]) than that of non-Hispanic older White persons. Discussion and Implications These findings may help comprehensively understand and address racial and ethnic disparities in dementia risk and may be integrated into existing dementia prevention programs to provide targeted interventions for community-dwelling older adults with differentiated social disadvantages.
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Affiliation(s)
- Yongjing Ping
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Economics, Yale University, New Haven, Connecticut, USA
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hanzhang Xu
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Community Health, School of Nursing, Duke University, Durham, North Carolina, USA
| | - Hao Xiang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, Hubei, China
- Global Health Institute of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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Lin Z, Ye J, Allore H, Gill TM, Chen X. Early-Life Circumstances and Racial Disparities in Cognition Among Older Adults in the US. JAMA Intern Med 2024; 184:904-914. [PMID: 38805197 PMCID: PMC11134283 DOI: 10.1001/jamainternmed.2024.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/29/2024] [Indexed: 05/29/2024]
Abstract
Importance Given the critical role of neurocognitive development in early life, understanding the association between early-life circumstances and racial disparities in cognition has important implications. Objective To assess whether racial differences in early-life circumstances are collectively and individually associated with racial disparities in late-life cognition among older adults in the US. Design, Setting, and Participants This cross-sectional study used comprehensive life history data from the Health and Retirement Study, a nationally representative survey of US adults 50 years or older. Data analyses were performed from August 9, 2022, to January 20, 2024. Main Outcomes and Measures Racial differences in early-life circumstances and racial disparities in late-life cognition were investigated using a Blinder-Oaxaca decomposition regression model. Cognitive outcomes, including cognitive score and cognitive impairment, were evaluated using the Telephone Interview for Cognitive Status. Early-life educational experiences were primary explanatory variables; early-life cohort, regional, financial, health, trauma, family relationship factors, and educational attainment were additional explanatory variables; demographic and genetic factors were covariates. Results The study sample comprised 9015 participants; 1634 non-Hispanic Black (hereafter, Black) individuals (18.1%) and 7381 non-Hispanic White (hereafter, White) individuals (81.9%). Among Black participants, the mean (SD) age was 69.2 (9.2) years and 1094 (67.0%) were women. Among White participants, the mean (SD) age was 73.2 (10.1) years and 4410 (59.7%) were women. Cognitive scores (scale, 0-27) were significantly lower among Black participants (13.5 [95% CI, 13.3-13.7] points) than among White participants (15.8 [95% CI, 15.7-15.9] points), while the prevalence of cognitive impairment (cognitive score <12) was significantly higher among Black participants (33.6 [95% CI, 31.3-35.9] percentage points [ppt]) than among White participants (16.4 [95% CI, 15.6-17.2] ppt). Substantial racial differences were observed in early-life circumstances. Overall, differences in early-life circumstances were associated with 61.5% of the racial disparities in cognitive score (1.4 [95% CI, 0.88-2.0] points), and 82.3% of the racial disparities in cognitive impairment (14.2 [95% CI, 8.8-19.5] ppt), respectively. In multivariable analyses, early-life educational experiences were associated with 35.2% of the disparities in cognitive score and 48.6% in cognitive impairment. Notably, school racial segregation (all segregated schooling before college) was associated with 28.8% to 39.7% of the racial disparities in cognition. These findings were consistent in a series of sensitivity analyses. Conclusions and Relevance The findings of this cross-sectional study suggest that less favorable early-life circumstances are associated with clinically meaningful racial disparities in late-life cognition. Policies that improve educational equity have the potential to reduce racial disparities in cognition in older ages. Clinicians may leverage early-life circumstances to promote the screening, prevention, and interventions of cognitive impairment more efficiently, thereby promoting health equity.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Justin Ye
- Department of Economics, Yale University, New Haven, Connecticut
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
- Yale Alzheimer’s Disease Research Center, New Haven, Connecticut
- Statistical Editor, JAMA Internal Medicine
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Department of Economics, Yale University, New Haven, Connecticut
- Yale Alzheimer’s Disease Research Center, New Haven, Connecticut
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Walsemann KM, Jackson H, Abbruzzi E, Ailshire JA. State-Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment. Milbank Q 2024. [PMID: 38984387 DOI: 10.1111/1468-0009.12709] [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: 08/30/2023] [Revised: 04/26/2024] [Accepted: 06/03/2024] [Indexed: 07/11/2024] Open
Abstract
Policy Points Education-cognition research overlooks the role of education quality in shaping cognitive function at midlife and older ages, even though quality may be more responsive to federal and state investment in public schooling than attainment. For older US adults who attended school during the early to mid-20th century, the quality of US education improved considerably as federal and state investment increased. Ensuring access to high-quality primary and secondary education may protect against poor cognitive function at midlife and older ages, particularly among Black Americans and persons who complete less education. It may also play an important role in reducing health inequities. CONTEXT Although educational attainment is consistently associated with better cognitive function among older adults, we know little about how education quality is related to cognitive function. This is a key gap in the literature given that the quality of US education improved considerably during the early to mid-20th century as state and federal investment increased. We posit that growing up in states with higher-quality education systems may protect against poor cognitive function, particularly among Black adults and adults who completed fewer years of school. METHODS We used prospective data on cognitive function from the Health and Retirement Study linked to historical data on state investment in public schools, restricting our sample to non-Hispanic White and Black adults born between 1914 and 1959 (19,096 White adults and 4,625 Black adults). Using race-stratified linear mixed models, we considered if state-level education quality was associated with level and decline in cognitive function and if these patterns differed by years of schooling and race. FINDINGS Residing in states with higher-resourced education systems during childhood was associated with better cognitive function, particularly among those who completed less than 12 years of schooling, regardless of race. For White adults, higher-resourced state education systems were associated with higher scores of total cognitive function and episodic memory, but there were diminishing returns as resources increased to very high levels. For Black adults, the relationship between state education resources and cognitive function varied by age with positive associations in midlife and generally null or negative associations at the oldest ages. CONCLUSIONS Federal and state investment in public schools may provide students with opportunities to develop important cognitive resources during schooling that translate into better cognitive function in later life, especially among marginalized populations.
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Affiliation(s)
- Katrina M Walsemann
- School of Public Policy, University of Maryland
- Maryland Population Research Center, University of Maryland
| | - Heide Jackson
- Maryland Population Research Center, University of Maryland
| | - Emily Abbruzzi
- School of Public Policy, University of Maryland
- Maryland Population Research Center, University of Maryland
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Lindauer A, Croff R, Duff K, Mattek N, Fuller P, Pierce A, Bonds K, Kaye J. The African American Dementia and Aging Project (AADAPt): An Oregon-based Longitudinal Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.06.24306831. [PMID: 38766213 PMCID: PMC11100851 DOI: 10.1101/2024.05.06.24306831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Objectives The vast majority of studies on aging, cognition, and dementia focus on non-Hispanic white subjects. This paper adds to the extant literature by providing insight into the African American aging experience. Here we describe the study design and baseline characteristics of the African American Dementia and Aging Project (AADAPt) study, which is exploring aging and cognition in African American older adults in Oregon. Methods African American older adults (n=177) participated in AADAPt, a longitudinal study that collected data on cognitive, physical, and social functioning in annual visits since 2000. Results AADAPt participants had risk factors for developing dementia in future, such as hypertension and hyperlipidemia, but also reported protective factors such as high social engagement. Conclusions The AADAPt project offers new insights into aging in older African Americans that includes data on cognition, social engagement, and physical health, which are crucial for understanding the experience of under-represented groups and making future studies more inclusive. These findings reflect a window of time for a geographically-focused cohort, and the lessons learned from this study likely have broader implications for shaping the health of these older African American adults. Keywords: African American, Dementia, Observational Study.
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Zhang YS, O’Shea B, Yu X, Cho TC, Zhang KP, Kler J, Langa KM, Weir DR, Gross AL, Kobayashi LC. Educational Attainment and Later-Life Cognitive Function in High- and Middle-Income Countries: Evidence From the Harmonized Cognitive Assessment Protocol. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae005. [PMID: 38284333 PMCID: PMC10997278 DOI: 10.1093/geronb/gbae005] [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: 08/12/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVES Identifying social policies that can promote cognitive health is crucial for reducing the global burden of dementia. We evaluated the importance of educational attainment for later-life cognitive function in various social and geographic settings. METHODS Using harmonized data for individuals aged ≥65 years from the United States Health and Retirement Study (HRS) and its international partner studies in England, Mexico, China, and India, and each study's respective Harmonized Cognitive Assessment Protocol (HCAP), we conducted a cross-national comparative study to examine the role of educational attainment in later-life cognitive function across countries (n = 14,980, 2016-2019). We used multivariable-adjusted regression to estimate associations between educational attainment and harmonized global cognitive function scores. RESULTS In Mexico, China, and India, the general cognitive function scores on average are approximately one standard deviation of the HRS-HCAP cognitive function score distribution lower compared to the United States and England, paralleling patterns of educational attainment across countries. In all countries, higher educational attainment was associated with progressively higher later-life cognitive function scores. Population-level differences in educational attainment explained about 50%-90% of the observed differences in cognitive function scores across countries. DISCUSSION The relationship between education and later-life cognitive function across social and geographic contexts underscores the crucial role of education to promote cognitive health and reduce dementia risk. Continual improvement of educational attainment in low- and middle-income settings may yield a significant pay-off in later-life cognitive health.
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Affiliation(s)
- Yuan S Zhang
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York, USA
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Brendan O’Shea
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Xuexin Yu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tsai-Chin Cho
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kelvin Pengyuan Zhang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jasdeep Kler
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Edmonds EC, Thomas KR, Rapcsak SZ, Lindemer SL, Delano‐Wood L, Salmon DP, Bondi MW. Data-driven classification of cognitively normal and mild cognitive impairment subtypes predicts progression in the NACC dataset. Alzheimers Dement 2024; 20:3442-3454. [PMID: 38574399 PMCID: PMC11095435 DOI: 10.1002/alz.13793] [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: 06/14/2023] [Revised: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Data-driven neuropsychological methods can identify mild cognitive impairment (MCI) subtypes with stronger associations to dementia risk factors than conventional diagnostic methods. METHODS Cluster analysis used neuropsychological data from participants without dementia (mean age = 71.6 years) in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (n = 26,255) and the "normal cognition" subsample (n = 16,005). Survival analyses examined MCI or dementia progression. RESULTS Five clusters were identified: "Optimal" cognitively normal (oCN; 13.2%), "Typical" CN (tCN; 28.0%), Amnestic MCI (aMCI; 25.3%), Mixed MCI-Mild (mMCI-Mild; 20.4%), and Mixed MCI-Severe (mMCI-Severe; 13.0%). Progression to dementia differed across clusters (oCN < tCN < aMCI < mMCI-Mild < mMCI-Severe). Cluster analysis identified more MCI cases than consensus diagnosis. In the "normal cognition" subsample, five clusters emerged: High-All Domains (High-All; 16.7%), Low-Attention/Working Memory (Low-WM; 22.1%), Low-Memory (36.3%), Amnestic MCI (16.7%), and Non-amnestic MCI (naMCI; 8.3%), with differing progression rates (High-All < Low-WM = Low-Memory < aMCI < naMCI). DISCUSSION Our data-driven methods outperformed consensus diagnosis by providing more precise information about progression risk and revealing heterogeneity in cognition and progression risk within the NACC "normal cognition" group.
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Affiliation(s)
- Emily C. Edmonds
- Banner Alzheimer's InstituteTucsonArizonaUSA
- Departments of Neurology and PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Kelsey R. Thomas
- Research Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Steven Z. Rapcsak
- Banner Alzheimer's InstituteTucsonArizonaUSA
- Departments of Neurology and PsychologyUniversity of ArizonaTucsonArizonaUSA
- Department of Speech, Language, & Hearing SciencesUniversity of ArizonaTucsonArizonaUSA
| | | | - Lisa Delano‐Wood
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - David P. Salmon
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
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Kapoor A, Ho JK, Jang JY, Nation DA. Robust reference group normative data for neuropsychological tests accounting for primary language use in Asian American older adults. J Int Neuropsychol Soc 2024; 30:402-409. [PMID: 38425303 PMCID: PMC11014765 DOI: 10.1017/s1355617723000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The present study aimed to develop neuropsychological norms for older Asian Americans with English as a primary or secondary language, using data from the National Alzheimer's Coordinating Center (NACC). METHOD A normative sample of Asian American participants was derived from the NACC database using robust criteria: participants were cognitively unimpaired at baseline (i.e., no MCI or dementia) and remained cognitively unimpaired at 1-year follow-up. Clinical and demographic characteristics were compared between Primary and Secondary English speakers using analyses of variance for continuous measures and chi-square tests for categorical variables. Linear regression models compared neuropsychological performance between the groups, adjusting for demographics (age, sex, and education). Regression models were developed for clinical application to compute demographically adjusted z-scores. RESULTS Secondary English speakers were younger than Primary English speakers (p < .001). There were significant differences between the groups on measures of mental status (Mini-Mental State Examination, p = .002), attention (Trail Making Test A, Digit Span Forward Total Score, p <.001), language (Boston Naming Test, Animal Fluency, Vegetable Fluency, p < .001), and executive function (Trail Making Test B, p = .02). CONCLUSIONS Separate normative data are needed for Primary vs. Secondary English speakers from Asian American backgrounds. We provide normative data on older Asian Americans to enable clinicians to account for English use in the interpretation of neuropsychological assessment scores.
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Affiliation(s)
- Arunima Kapoor
- Department of Psychological Science, University of California, Irvine
| | - Jean K. Ho
- Institute for Memory Disorders and Neurological Impairments, University of California, Irvine
| | - Jung Yun Jang
- Institute for Memory Disorders and Neurological Impairments, University of California, Irvine
| | - Daniel A. Nation
- Leonard Davis School of Gerontology, University of Southern California
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Zhu W, Tang H, Zhang H, Rajamohan HR, Huang SL, Ma X, Chaudhari A, Madaan D, Almahmoud E, Chopra S, Dodson JA, Brody AA, Masurkar AV, Razavian N. Predicting Risk of Alzheimer's Diseases and Related Dementias with AI Foundation Model on Electronic Health Records. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306180. [PMID: 38712223 PMCID: PMC11071573 DOI: 10.1101/2024.04.26.24306180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Early identification of Alzheimer's disease (AD) and AD-related dementias (ADRD) has high clinical significance, both because of the potential to slow decline through initiating FDA-approved therapies and managing modifiable risk factors, and to help persons living with dementia and their families to plan before cognitive loss makes doing so challenging. However, substantial racial and ethnic disparities in early diagnosis currently lead to additional inequities in care, urging accurate and inclusive risk assessment programs. In this study, we trained an artificial intelligence foundation model to represent the electronic health records (EHR) data with a vast cohort of 1.2 million patients within a large health system. Building upon this foundation EHR model, we developed a predictive Transformer model, named TRADE, capable of identifying risks for AD/ADRD and mild cognitive impairment (MCI), by analyzing the past sequential visit records. Amongst individuals 65 and older, our model was able to generate risk predictions for various future timeframes. On the held-out validation set, our model achieved an area under the receiver operating characteristic (AUROC) of 0.772 (95% CI: 0.770, 0.773) for identifying the AD/ADRD/MCI risks in 1 year, and AUROC of 0.735 (95% CI: 0.734, 0.736) in 5 years. The positive predictive values (PPV) in 5 years among individuals with top 1% and 5% highest estimated risks were 39.2% and 27.8%, respectively. These results demonstrate significant improvements upon the current EHR-based AD/ADRD/MCI risk assessment models, paving the way for better prognosis and management of AD/ADRD/MCI at scale.
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Affiliation(s)
- Weicheng Zhu
- NYU, Center for Data Science, New York, NY, 10001, USA
| | - Huanze Tang
- NYU, Center for Data Science, New York, NY, 10001, USA
| | - Hao Zhang
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
| | | | | | - Xinyue Ma
- NYU, Center for Data Science, New York, NY, 10001, USA
| | | | - Divyam Madaan
- NYU, Courant Institute of Mathematical Sciences, New York, NY, 10001, USA
| | - Elaf Almahmoud
- NYU, Courant Institute of Mathematical Sciences, New York, NY, 10001, USA
| | - Sumit Chopra
- NYU, Courant Institute of Mathematical Sciences, New York, NY, 10001, USA
- NYU Grossman School of Medicine, Department of Radiology, New York, NY, 10016, USA
| | - John A. Dodson
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- NYU Grossman School of Medicine, Department of Medicine, New York, NY, 10016, USA
| | - Abraham A. Brody
- NYU Grossman School of Medicine, Department of Medicine, New York, NY, 10016, USA
- NYU Grossman School of Medicine, Rory Meyers College of Nursing, Hartford Institute for Geriatric Nursing, New York, NY, 10016, USA
| | - Arjun V. Masurkar
- NYU Grossman School of Medicine, Department of Neurology, New York, NY, 10016, USA
- NYU Grossman School of Medicine, Department of Neuroscience and Physiology, New York, NY, 10016, USA
- NYU Grossman School of Medicine, Neuroscience Institute, New York, NY, 10016, USA
| | - Narges Razavian
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, 10016, USA
- NYU Grossman School of Medicine, Department of Radiology, New York, NY, 10016, USA
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15
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Seifar F, Fox EJ, Shantaraman A, Liu Y, Dammer EB, Modeste E, Duong DM, Yin L, Trautwig AN, Guo Q, Xu K, Ping L, Reddy JS, Allen M, Quicksall Z, Heath L, Scanlan J, Wang E, Wang M, Linden AV, Poehlman W, Chen X, Baheti S, Ho C, Nguyen T, Yepez G, Mitchell AO, Oatman SR, Wang X, Carrasquillo MM, Runnels A, Beach T, Serrano GE, Dickson DW, Lee EB, Golde TE, Prokop S, Barnes LL, Zhang B, Haroutunian V, Gearing M, Lah JJ, Jager PD, Bennett DA, Greenwood A, Ertekin-Taner N, Levey AI, Wingo A, Wingo T, Seyfried NT. Large-scale Deep Proteomic Analysis in Alzheimer's Disease Brain Regions Across Race and Ethnicity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.22.590547. [PMID: 38712030 PMCID: PMC11071432 DOI: 10.1101/2024.04.22.590547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Introduction Alzheimer's disease (AD) is the most prevalent neurodegenerative disease, yet our comprehension predominantly relies on studies within the non-Hispanic White (NHW) population. Here we aimed to provide comprehensive insights into the proteomic landscape of AD across diverse racial and ethnic groups. Methods Dorsolateral prefrontal cortex (DLPFC) and superior temporal gyrus (STG) brain tissues were donated from multiple centers (Mayo Clinic, Emory University, Rush University, Mt. Sinai School of Medicine) and were harmonized through neuropathological evaluation, specifically adhering to the Braak staging and CERAD criteria. Among 1105 DLPFC tissue samples (998 unique individuals), 333 were from African American donors, 223 from Latino Americans, 529 from NHW donors, and the rest were from a mixed or unknown racial background. Among 280 STG tissue samples (244 unique individuals), 86 were African American, 76 Latino American, 116 NHW and the rest were mixed or unknown ethnicity. All tissues were uniformly homogenized and analyzed by tandem mass tag mass spectrometry (TMT-MS). Results As a Quality control (QC) measure, proteins with more than 50% missing values were removed and iterative principal component analysis was conducted to remove outliers within brain regions. After QC, 9,180 and 9,734 proteins remained in the DLPC and STG proteome, respectively, of which approximately 9,000 proteins were shared between regions. Protein levels of microtubule-associated protein tau (MAPT) and amyloid-precursor protein (APP) demonstrated AD-related elevations in DLPFC tissues with a strong association with CERAD and Braak across racial groups. APOE4 protein levels in brain were highly concordant with APOE genotype of the individuals. Discussion This comprehensive region resolved large-scale proteomic dataset provides a resource for the understanding of ethnoracial-specific protein differences in AD brain.
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Affiliation(s)
| | - Edward J Fox
- Emory University School of Medicine, Atlanta, GA USA
| | | | - Yue Liu
- Emory University School of Medicine, Atlanta, GA USA
| | - Eric B Dammer
- Emory University School of Medicine, Atlanta, GA USA
| | - Erica Modeste
- Emory University School of Medicine, Atlanta, GA USA
| | - Duc M Duong
- Emory University School of Medicine, Atlanta, GA USA
| | - Luming Yin
- Emory University School of Medicine, Atlanta, GA USA
| | | | - Qi Guo
- Emory University School of Medicine, Atlanta, GA USA
| | - Kaiming Xu
- Emory University School of Medicine, Atlanta, GA USA
| | - Lingyan Ping
- Emory University School of Medicine, Atlanta, GA USA
| | - Joseph S Reddy
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Mariet Allen
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Zachary Quicksall
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | | | | | - Erming Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Minghui Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | | | - Xianfeng Chen
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Saurabh Baheti
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Charlotte Ho
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Thuy Nguyen
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Geovanna Yepez
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | | | | | - Xue Wang
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | | | | | - Thomas Beach
- Banner Sun Health Research Institute, Sun City, AR USA
| | | | - Dennis W Dickson
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelpha, PA, USA
| | - Todd E Golde
- Emory University School of Medicine, Atlanta, GA USA
| | | | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL USA
| | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Varham Haroutunian
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Marla Gearing
- Emory University School of Medicine, Atlanta, GA USA
| | - James J Lah
- Emory University School of Medicine, Atlanta, GA USA
| | | | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL USA
| | | | - Nilüfer Ertekin-Taner
- Mayo Clinic Florida, Department of Neuroscience, Jacksonville, FL USA
- Mayo Clinic Florida, Department of Neurology, Jacksonville, FL USA
| | - Allan I Levey
- Emory University School of Medicine, Atlanta, GA USA
| | - Aliza Wingo
- Emory University School of Medicine, Atlanta, GA USA
| | - Thomas Wingo
- Emory University School of Medicine, Atlanta, GA USA
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Adkins-Jackson PB, Kim B, Higgins Tejera C, Ford TN, Gobaud AN, Sherman-Wilkins KJ, Turney IC, Avila-Rieger JF, Sims KD, Okoye SM, Belsky DW, Hill-Jarrett TG, Samuel L, Solomon G, Cleeve JH, Gee G, Thorpe RJ, Crews DC, Hardeman RR, Bailey ZD, Szanton SL, Manly JJ. "Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black. Health Equity 2024; 8:254-268. [PMID: 38665381 PMCID: PMC11043623 DOI: 10.1089/heq.2023.0151] [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] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.
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Affiliation(s)
- Paris B. Adkins-Jackson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - César Higgins Tejera
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tiffany N. Ford
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- The Brookings Institution, Washington, District of Columbia, USA
| | - Ariana N. Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Indira C. Turney
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Justina F. Avila-Rieger
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Safiyyah M. Okoye
- Department of Graduate Nursing, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Health Management and Policy, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tanisha G. Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabriella Solomon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jack H. Cleeve
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Gilbert Gee
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Roland J. Thorpe
- Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deidra C. Crews
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel R. Hardeman
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Zinzi D. Bailey
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sarah L. Szanton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Manly
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
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Ganasegeran K, Abdul Manaf MR, Safian N, Waller LA, Mustapha FI, Abdul Maulud KN, Mohd Rizal MF. How Socio-economic Inequalities Cluster People with Diabetes in Malaysia: Geographic Evaluation of Area Disparities Using a Non-parameterized Unsupervised Learning Method. J Epidemiol Glob Health 2024; 14:169-183. [PMID: 38315406 PMCID: PMC11043261 DOI: 10.1007/s44197-023-00185-2] [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: 08/31/2023] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
Accurate assessments of epidemiological associations between health outcomes and routinely observed proximal and distal determinants of health are fundamental for the execution of effective public health interventions and policies. Methods to couple big public health data with modern statistical techniques offer greater granularity for describing and understanding data quality, disease distributions, and potential predictive connections between population-level indicators with areal-based health outcomes. This study applied clustering techniques to explore patterns of diabetes burden correlated with local socio-economic inequalities in Malaysia, with a goal of better understanding the factors influencing the collation of these clusters. Through multi-modal secondary data sources, district-wise diabetes crude rates from 271,553 individuals with diabetes sampled from 914 primary care clinics throughout Malaysia were computed. Unsupervised machine learning methods using hierarchical clustering to a set of 144 administrative districts was applied. Differences in characteristics of the areas were evaluated using multivariate non-parametric test statistics. Five statistically significant clusters were identified, each reflecting different levels of diabetes burden at the local level, each with contrasting patterns observed under the influence of population-level characteristics. The hierarchical clustering analysis that grouped local diabetes areas with varying socio-economic, demographic, and geographic characteristics offer opportunities to local public health to implement targeted interventions in an attempt to control the local diabetes burden.
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Affiliation(s)
- Kurubaran Ganasegeran
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
- Clinical Research Center, Seberang Jaya Hospital, Ministry of Health Malaysia, 13700, George Town, Penang, Malaysia.
| | - Mohd Rizal Abdul Manaf
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Nazarudin Safian
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Feisul Idzwan Mustapha
- Public Health Division, Perak State Health Department, Ministry of Health Malaysia, 30000, Ipoh, Perak, Malaysia
| | - Khairul Nizam Abdul Maulud
- Earth Observation Centre (EOC), Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor Darul Ehsan, Malaysia
- Department of Civil Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor Darul Ehsan, Malaysia
| | - Muhammad Faid Mohd Rizal
- Earth Observation Centre (EOC), Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor Darul Ehsan, Malaysia
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Torres JM, Flores Romero KR, Kotwal AA, Chen R, Hill‐Jarrett T, Mitchell UA, Glymour MM. Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study. Alzheimers Dement 2024; 20:1562-1572. [PMID: 38041823 PMCID: PMC10984471 DOI: 10.1002/alz.13555] [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: 07/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia. METHODS Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities. RESULTS Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common. DISCUSSION Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.
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Affiliation(s)
- Jacqueline M. Torres
- Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Karla Renata Flores Romero
- Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Ashwin A. Kotwal
- Division of GeriatricsDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Geriatrics, Palliative, and Extended Care Service LineSan Francisco Veterans Affairs Medical CenterSan FranciscoCaliforniaUSA
| | - Ruijia Chen
- Department of EpidemiologySchool of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Tanisha Hill‐Jarrett
- Memory and Aging CenterDepartment of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Uchechi A. Mitchell
- Division of Community Health SciencesSchool of Public HealthUniversity of IllinoisChicagoIllinoisUSA
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Song Y, Wu F, Sharma S, Clendenen TV, India‐Aldana S, Afanasyeva Y, Gu Y, Koenig KL, Zeleniuch‐Jacquotte A, Chen Y. Mid-life adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and late-life subjective cognitive complaints in women. Alzheimers Dement 2024; 20:1076-1088. [PMID: 37861080 PMCID: PMC10917042 DOI: 10.1002/alz.13468] [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: 03/21/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Evidence is limited on the role of mid-life Dietary Approaches to Stop Hypertension (DASH) diet in late-life subjective cognitive complaints (SCCs). METHODS We included 5116 women (mean age in 1985-1991: 46 years) from the New York University Women's Health Study. SCCs were assessed from 2018 to 2020 (mean age: 79 years) by a 6-item questionnaire. RESULTS Compared to women in the bottom quartile of the DASH scores, the odds ratio (OR) for having two or more SCCs was 0.83 (95% confidence interval: 0.70-0.99) for women in the top quartile of DASH scores at baseline (P for trend = 0.019). The association was similar with multiple imputation and inverse probability weighting to account for potential selection bias. The inverse association was stronger in women without a history of cancer (P for interaction = 0.003). DISCUSSION Greater adherence to the DASH diet in mid-life was associated with lower prevalence of late-life SCCs in women.
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Affiliation(s)
- Yixiao Song
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
- Department of EpidemiologyNYU School of Global Public HealthNew YorkNew YorkUSA
| | - Fen Wu
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Sneha Sharma
- NYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Tess V. Clendenen
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Sandra India‐Aldana
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Yelena Afanasyeva
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Yian Gu
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
- Taub Institute for Research in Alzheimer's Disease and the Aging BrainColumbia UniversityNew YorkNew YorkUSA
| | - Karen L. Koenig
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Anne Zeleniuch‐Jacquotte
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Yu Chen
- Division of EpidemiologyDepartment of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
- Department of Environmental MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
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20
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Peterson RL, Pejak R, George KM, Gilsanz P, Ko M, Meyer OL, Mayeda ER, Kind A, Whitmer RA. Race, community disadvantage, and cognitive decline: Findings from KHANDLE and STAR. Alzheimers Dement 2024; 20:904-913. [PMID: 37817548 PMCID: PMC10917037 DOI: 10.1002/alz.13511] [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: 05/25/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Community disadvantage is associated with late-life cognition. Few studies examine its contribution to racial disparities in cognition/cognitive change. METHODS Inverse probability weighted models estimated expected mean differences in cognition/cognitive change attributed to residing in less advantaged communities, defined as cohort top quintile of Area Deprivation Indices (ADI): childhood 66-100; adulthood ADI 5-99). Interactions by race tested. RESULTS More Black participants resided in less advantaged communities. Semantic memory would be lower if all participants had resided in less advantaged childhood (b = -0.16, 95% confidence interval [CI] = -0.30, -0.03) or adulthood (b = -0.14, 95% CI = -0.22, -0.04) communities. Race interactions indicated that, among Black participants, less advantaged childhood communities were associated with higher verbal episodic memory (interaction p-value = 0.007) and less advantaged adulthood communities were associated with lower semantic memory (interaction p-value = 0.002). DISCUSSION Examining racial differences in levels of community advantage and late-life cognitive decline is a critical step toward unpacking community effects on cognitive disparities.
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Affiliation(s)
- Rachel L. Peterson
- School of Public and Community Health SciencesUniversity of MontanaMissoulaMontanaUSA
| | - Rebecca Pejak
- School of Public and Community Health SciencesUniversity of MontanaMissoulaMontanaUSA
| | - Kristen M. George
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Paola Gilsanz
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Michelle Ko
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Oanh L. Meyer
- Department of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | - Elizabeth Rose Mayeda
- Fielding School of Public HealthUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Amy Kind
- University of Wisconsin Center for Health Disparities ResearchMadisonWisconsinUSA
| | - Rachel A. Whitmer
- Departments of Public Health Sciences and NeurologyUniversity of California DavisDavisCaliforniaUSA
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De Anda‐Duran I, Sunderaraman P, Searls E, Moukaled S, Jin X, Popp Z, Karjadi C, Hwang PH, Ding H, Devine S, Shih LC, Low S, Lin H, Kolachalama VB, Bazzano L, Libon DJ, Au R. Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts. J Am Heart Assoc 2024; 13:e032733. [PMID: 38226519 PMCID: PMC10926794 DOI: 10.1161/jaha.123.032733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based cognitive assessments have emerged as promising tools, bridging gaps in accessibility and reducing bias in Alzheimer disease and related dementia research. However, their congruence with traditional neuropsychological tests and usefulness in diverse cohorts remain underexplored. METHODS AND RESULTS A total of 406 FHS (Framingham Heart Study) and 59 BHS (Bogalusa Heart Study) participants with traditional neuropsychological tests and digital assessments using the Defense Automated Neurocognitive Assessment (DANA) smartphone protocol were included. Regression models investigated associations between DANA task digital measures and a neuropsychological global cognitive Z score (Global Cognitive Score [GCS]), and neuropsychological domain-specific Z scores. FHS participants' mean age was 57 (SD, 9.75) years, and 44% (179) were men. BHS participants' mean age was 49 (4.4) years, and 28% (16) were men. Participants in both cohorts with the lowest neuropsychological performance (lowest quartile, GCS1) demonstrated lower DANA digital scores. In the FHS, GCS1 participants had slower average response times and decreased cognitive efficiency scores in all DANA tasks (P<0.05). In BHS, participants in GCS1 had slower average response times and decreased cognitive efficiency scores for DANA Code Substitution and Go/No-Go tasks, although this was not statistically significant. In both cohorts, GCS was significantly associated with DANA tasks, such that higher GCS correlated with faster average response times (P<0.05) and increased cognitive efficiency (all P<0.05) in the DANA Code Substitution task. CONCLUSIONS Our findings demonstrate that smartphone-based cognitive assessments exhibit concurrent validity with a composite measure of traditional neuropsychological tests. This supports the potential of using smartphone-based assessments in cognitive screening across diverse populations and the scalability of digital assessments to community-dwelling individuals.
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Affiliation(s)
- Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Edward Searls
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Shirine Moukaled
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Xuanyi Jin
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Zachary Popp
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Cody Karjadi
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Sherral Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Honghuang Lin
- University of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Computer ScienceBoston UniversityBostonMAUSA
| | - Lydia Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - David J. Libon
- Department of PsychologyRowan UniversityMullica HillNJUSA
- New Jersey Institute of Successful AgingRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Rhoda Au
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
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22
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Jiang X, Bahorik AL, Graff-Radford NR, Yaffe K. Association of Plasma Amyloid-β and Dementia Among Black and White Older Adults. J Alzheimers Dis 2024; 99:787-797. [PMID: 38701147 DOI: 10.3233/jad-240007] [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] [Indexed: 05/05/2024]
Abstract
Background Plasma amyloid-β (Aβ) has emerged as an important tool to detect risks of Alzheimer's disease and related dementias, although research in diverse populations is lacking. Objective We compared plasma Aβ42/40 by race with dementia risk over 15 years among Black and White older adults. Methods In a prospective cohort of 997 dementia-free participants (mean age 74±2.9 years, 55% women, 54% Black), incident dementia was identified based on hospital records, medication, and neurocognitive test over 15 years. Plasma Aβ42/40 was measured at Year 2 and categorized into low, medium, and high tertile. We used linear regression to estimate mean Aβ42/40 by race and race-stratified Cox proportional hazards models to assess the association between Aβ42/40 tertile and dementia risk. Results Black participants had a lower age-adjusted mean Aβ 42/40 compared to White participants, primarily among APOE ɛ4 non-carriers (Black: 0.176, White: 0.185, p = 0.035). Among Black participants, lower Aβ 42/40 was associated with increased dementia risk: 33% in low (hazard ratios [HR] = 1.77, 95% confidence interval 1.09-2.88) and 27% in medium tertile (HR = 1.67, 1.01-2.78) compared with 18% in high Aβ 42/40 tertile; Increased risks were attenuated among White participants: 21% in low (HR = 1.43, 0.81-2.53) and 23% in medium tertile (HR = 1.27, 0.68-2.36) compared with 15% in high Aβ 42/40 tertile. The interaction by race was not statistically significant. Conclusions Among community-dwelling, non-demented older adults, especially APOE ɛ4 non-carriers, Black individuals had lower plasma Aβ 42/40 and demonstrated a higher dementia risk with low Aβ42/40 compared with White individuals.
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Affiliation(s)
- Xiaqing Jiang
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Amber L Bahorik
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
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Zare H, Najand B, Fugal A, Assari S. Allostatic load in the US general population: Race and educational intersection. PUBLIC HEALTH IN PRACTICE 2023; 6:100425. [PMID: 37711501 PMCID: PMC10498186 DOI: 10.1016/j.puhip.2023.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Objectives Educational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group. Study design This cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS<4 as 0) to present elevated AL. Methods We used several weighted modified Poisson regression models controlling for educational attainment (a predictor) and race (a moderator variable), age, sex, and marital status. We also controlled the models for smoking and drinking status as health behavior variables. As a sensitivity analysis, we ran several sets of regression analysis using the AL scale as a continuous outcome variable. Results We found an inverse association between AL and educational attainment. The interaction between race and education has resulted in an inverse association between AL and educational attainment, with a weaker association in black people than in white people. We found similar findings by running regression models with AL as a continuous variable. Conclusions We observed a weaker association between educational attainment and AL in black people than in white people, suggesting that educational attainment has more robust protection against allostatic load for white people than black people.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, 20774, USA
| | - Babak Najand
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Adriele Fugal
- Utah Valley University, 800 W University Pkwy, Orem, UT, 84058, USA
| | - Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, 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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Zahodne LB, Brauer S, Tarraf W, Morris EP, Antonucci TC, Ajrouch KJ. Measurement and structural invariance of a neuropsychological battery among Middle Eastern/North African, Black, and White older adults. Neuropsychology 2023; 37:975-984. [PMID: 36996172 PMCID: PMC10544699 DOI: 10.1037/neu0000902] [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: 04/01/2023] Open
Abstract
OBJECTIVE There is a lack of guidance on common neuropsychological measures among Arabic speakers and individuals who identify as Middle Eastern/North African (MENA) in the United States. This study evaluated measurement and structural invariance of a neuropsychological battery across race/ethnicity (MENA, Black, White) and language (Arabic, English). METHOD Six hundred six older adults (128 MENA-English, 74 MENA-Arabic, 207 Black, 197 White) from the Detroit Area Wellness Network were assessed via telephone. Multiple-group confirmatory factor analyses examined four indicators corresponding to distinct cognitive domains: episodic memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] Word List), language (Animal Fluency), attention (Montreal Cognitive Assessment [MoCA] forward digit span), and working memory (MoCA backward digit span). RESULTS Measurement invariance analyses revealed full scalar invariance across language groups and partial scalar invariance across racial/ethnic groups suggesting a White testing advantage on Animal Fluency; yet this noninvariance did not meet a priori criteria for salient impact. Accounting for measurement noninvariance, structural invariance analyses revealed that MENA participants tested in English demonstrated lower cognitive health than Whites and Blacks, and MENA participants tested in Arabic demonstrated lower cognitive health than all other groups. CONCLUSIONS Measurement invariance results support the use of a rigorously translated neuropsychological battery to assess global cognitive health across MENA/Black/White and Arabic/English groups. Structural invariance results reveal underrecognized cognitive disparities. Disaggregating MENA older adults from other non-Latinx Whites will advance research on cognitive health equity. Future research should attend to heterogeneity within the MENA population, as the choice to be tested in Arabic versus English may reflect immigrant, educational, and socioeconomic experiences relevant to cognitive aging. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Simon Brauer
- Institute for Social Research, University of Michigan
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Beltran-Najera I, Thompson JL, Matchanova A, Woods SP. Racial differences in scores on the HIV Dementia Scale: mediating effects of literacy and screening utility among Black and White persons with HIV disease. AIDS Care 2023; 35:1724-1731. [PMID: 36314429 PMCID: PMC10148926 DOI: 10.1080/09540121.2022.2132373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/28/2022] [Indexed: 05/01/2023]
Abstract
There are many obstacles to screening for HIV-associated neurocognitive disorders (HAND), including the influence of various sociodemographic effects on screening measures. This study examined possible racial bias on the HIV Dementia Scale (HDS) in screening for HAND among 39 Black and 84 White persons living with HIV (PLWH). Black PLWH had significantly lower raw HDS scores than White PLWH, which was mediated by lower oral word reading scores. Nevertheless, HDS scores were comparably predictive of clinical HAND diagnoses for Black and White PLWH as determined by a comprehensive battery; overall, individuals who failed the HDS were three times as likely to have HAND as compared to those who performed within normal limits (sensitivity = .26, specificity = .94). Consistent with prior literature exploring race-group differences, findings suggest that lower scores among Black PLWH compared to White PLWH on a commonly-used screening measure for HAND are partly explained by reading scores, perhaps reflecting differences in educational quality and opportunities. However, race-group differences did not affect the classification accuracy of the HDS in detecting HAND, although overall diagnostic accuracy was modest in both groups. Future work should determine the optimal neurocognitive screening methods for Black PLWH and other under-represented ethnoracial groups.
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Owens J, Jones R, Marsiske M. The Effects of Occupational Complexity on Late Life Cognition in ACTIVE: Examining the Mediating and Moderating Effects of Race. J Aging Health 2023; 35:95S-106S. [PMID: 37994851 PMCID: PMC11160436 DOI: 10.1177/08982643211038837] [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: 11/24/2023]
Abstract
Objectives: This article sought to determine (1) whether occupational complexity (OC) explains individual differences in cognition at baseline, (2) whether this relationship is differentially related to cognition by Black/White race, and (3) whether OC mediates some or all of the Black/White race-related variance in late life cognition. Methods: 2371 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study reported longest held jobs and received OC ratings based on a factor analysis of 63 variables from the Dictionary of Occupational Titles. Results: We found that multiple dimensions of OC are related to cognition, but there were relatively few Black/White differences in these associations. Across all cognitive dimensions except for useful field of view, a history of having jobs lower in substantive complexity and fine motor skills and higher in physical demands may explain some of the Black/White race differences in elder's cognition. Discussion: We conclude that occupations can be a target to reduce social disparities in late life cognition.
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Affiliation(s)
- Joshua Owens
- Department of Clinical and Health Psychology, University of Florida
| | | | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
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Pope CN, Wheeler KM, Bell TR, Carroll BE, Ross LA, Crowe M, Black SR, Clay OJ, Ball KK. Social and Neighborhood Context Moderates the Associations Between Processing Speed and Driving Mobility: A 10-year Analysis of the ACTIVE Study. J Aging Health 2023; 35:26S-39S. [PMID: 37994848 DOI: 10.1177/08982643231163907] [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: 11/24/2023]
Abstract
Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study (n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility.
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Affiliation(s)
- Caitlin N Pope
- Department of Health, Behavior and Society, University of Kentucky, Lexington, KY, USA
| | - Katie M Wheeler
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Tyler R Bell
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brooke E Carroll
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Lesley A Ross
- Department of Psychology, Clemson University, SC, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Shelia R Black
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, AL, USA
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Sharma S, Hale JM, Myrskylä M, Kulu H. Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016. Demography 2023; 60:1441-1468. [PMID: 37638648 DOI: 10.1215/00703370-10941414] [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: 08/29/2023]
Abstract
Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.
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Affiliation(s)
- Shubhankar Sharma
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of St Andrews, St Andrews, Scotland
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Jo Mhairi Hale
- University of St Andrews, St Andrews, Scotland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Hill Kulu
- University of St Andrews, St Andrews, Scotland
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Steinberg N, Parisi JM, Feger DM, Clay OJ, Willis SL, Ball KK, Marsiske M, Harrell ER, Sisco SM, Rebok GW. Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial. J Aging Health 2023; 35:107S-118S. [PMID: 35604034 DOI: 10.1177/08982643221102718] [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: 11/15/2022]
Abstract
ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.
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Affiliation(s)
- Nessa Steinberg
- Marcus Institute for Aging, Hebrew SeniorLife, Boston, MA, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Danielle M Feger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
- University of Alabama Alzheimer's Disease Research Center, Birmingham, AL, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
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31
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Palms JD, Zaheed AB, Morris EP, Martino A, Meister L, Sol K, Zahodne LB. Links between early-life contextual factors and later-life cognition and the role of educational attainment. J Int Neuropsychol Soc 2023; 29:734-741. [PMID: 36537155 PMCID: PMC10279802 DOI: 10.1017/s135561772200090x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Educational attainment is a well-documented predictor of later-life cognition, but less is known about upstream contextual factors. This study aimed to identify which early-life contextual factors uniquely predict later-life global cognition and whether educational attainment mediates these relationships. METHOD Participants were drawn from the Michigan Cognitive Aging Project (N = 485; Mage = 63.51; SDage = 3.13; 50% non-Hispanic Black). Early-life exposures included U.S. region of elementary school (Midwest, South, Northeast), average parental education, household composition (number of adults (1, 2, 3+), number of children), school racial demographics (predominantly White, predominantly Black, diverse), self-reported educational quality, and school type (public/private). Later-life global cognition was operationalized with a factor score derived from a comprehensive neuropsychological battery. Sequential mediation models controlling for sociodemographics estimated total, direct, and indirect effects of early-life contextual factors on cognition through educational attainment (years). RESULTS Higher educational quality, higher parental education, and attending a private school were each associated with better cognition; attending a predominantly Black or diverse school and reporting three or more adults in the household were associated with lower cognition. After accounting for educational attainment, associations remained for educational quality, school type, and reporting three or more adults in the household. Indirect effects through educational attainment were observed for school region, educational quality, school racial demographics, and parental education. CONCLUSIONS School factors appear to consistently predict later-life cognition more than household factors, highlighting the potential long-term benefits of school-level interventions for cognitive aging. Future research should consider additional mediators beyond educational attainment such as neighborhood resources and childhood adversity.
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Affiliation(s)
- Jordan D Palms
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Martino
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Lindsey Meister
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ketlyne Sol
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Jester DJ, Palmer BW, Thomas ML, Brown LL, Tibiriçá L, Jeste DV, Gilmer T. Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults. J Am Geriatr Soc 2023; 71:2913-2923. [PMID: 37073606 PMCID: PMC10523883 DOI: 10.1111/jgs.18340] [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: 10/13/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality. METHODS We examined 20,311 Black, Latinx, and White adults aged 51-100 from the Health and Retirement Study (2008-2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates. RESULTS On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age. CONCLUSIONS The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults.
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Affiliation(s)
- Dylan J. Jester
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
- Psychology Division, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO
| | - Lauren L. Brown
- Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, CA
| | - Lize Tibiriçá
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California
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Logue MW, Dasgupta S, Farrer LA. Genetics of Alzheimer's Disease in the African American Population. J Clin Med 2023; 12:5189. [PMID: 37629231 PMCID: PMC10455208 DOI: 10.3390/jcm12165189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Black/African American (AA) individuals have a higher risk of Alzheimer's disease (AD) than White non-Hispanic persons of European ancestry (EUR) for reasons that may include economic disparities, cardiovascular health, quality of education, and biases in the methods used to diagnose AD. AD is also heritable, and some of the differences in risk may be due to genetics. Many AD-associated variants have been identified by candidate gene studies, genome-wide association studies (GWAS), and genome-sequencing studies. However, most of these studies have been performed using EUR cohorts. In this paper, we review the genetics of AD and AD-related traits in AA individuals. Importantly, studies of genetic risk factors in AA cohorts can elucidate the molecular mechanisms underlying AD risk in AA and other populations. In fact, such studies are essential to enable reliable precision medicine approaches in persons with considerable African ancestry. Furthermore, genetic studies of AA cohorts allow exploration of the ways the impact of genes can vary by ancestry, culture, and economic and environmental disparities. They have yielded important gains in our knowledge of AD genetics, and increasing AA individual representation within genetic studies should remain a priority for inclusive genetic study design.
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Affiliation(s)
- Mark W. Logue
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA;
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Shoumita Dasgupta
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA;
- Department of Medical Sciences and Education, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA;
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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Jester DJ, Kohn JN, Tibiriçá L, Thomas ML, Brown LL, Murphy JD, Jeste DV. Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults. Am J Psychiatry 2023; 180:483-494. [PMID: 37038741 PMCID: PMC10329971 DOI: 10.1176/appi.ajp.20220158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE The authors sought to determine the impact of selected social determinants of health (SDoH) on psychological health and well-being (defined as depression, cognition, and self-rated health) among Black and Hispanic/Latinx adults relative to White adults 51-89 years of age. METHODS Disparities in depressive symptomatology, cognition, and self-rated health were measured among 2,306 non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 non-Hispanic/Latinx White adults who participated in the Health and Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected SDoH explained a larger share of the disparities than age, sex, measures of health, health behaviors, and health care utilization. Selected SDoH included education, parental education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage. RESULTS Black and Hispanic/Latinx adults reported worse depressive symptomatology, cognition, and self-rated health than White adults. Selected SDoH were associated with a larger proportion of the Black-White disparities in depressive symptomatology (51%), cognition (39%), and self-rated health (37%) than were age, sex, measures of health, health behaviors, and health care utilization. SDoH were associated with a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and physical health correlated with the disparity in depressive symptomatology (28%). Education, parental education, years worked, income, and insurance parity were SDoH associated with these disparities. CONCLUSIONS Differences in SDoH underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key SDoH.
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Affiliation(s)
- Dylan J. Jester
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Lize Tibiriçá
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO
| | - Lauren L. Brown
- Divison of Health Management and Policy, School of Public Health, San Diego State University, San Diego, CA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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Niino M, Miyazaki Y, Altincatal A, Belviso N, Kanda M, Chinen I, Edwards M, de Moor C, Williams JR, Rao SM. Processing speed test: Results from a Japanese normative sample of healthy participants compared with a US normative sample. Clin Neurol Neurosurg 2023; 230:107790. [PMID: 37229953 DOI: 10.1016/j.clineuro.2023.107790] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The Processing Speed Test (PST), a validated iPad®-based cognitive screening test for MS, has been applied to the cognitive assessment of Japanese MS patients using US normative data. METHODS To develop PST normative data from Japanese healthy volunteers and compare the PST score distribution between Japanese and US healthy volunteers, 254 healthy Japanese-speaking volunteers were enrolled and stratified by age (20-65 years). Potential participants with a Mini-Mental State Examination score < 27 were excluded. PST raw scores (total correct) were from the Japan cohort and compared with age-restricted US normative data and propensity score-matched data created by matching sex, age, and educational level from a published study of 428 healthy participants. PST score distributions and standardized z-scores were compared using t-test and Kolmogorov-Smirnov test statistics. RESULTS The mean age of the Japan cohort was 44.1 years. The PST scores of Japanese volunteers were significantly different from those of the age-restricted (mean ± SD 61.8 ± 10.1 vs 53.7 ± 10.8; p < 0.001) and the propensity score-matched US cohort (62.1 ± 10.1 vs 53.3 ± 10.6; p < 0.001). CONCLUSION Regression analyses centered on US normative data could underestimate disease severity in Japanese MS patients, suggesting that separate normative data should be considered for each population sample.
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Affiliation(s)
- Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.
| | - Yusei Miyazaki
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | | | | | | | | | | | | | | | - Stephen M Rao
- Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Frank CC, Mundy LM, Smith J. Life course engagement in enriching activities: When and how does it matter for cognitive aging? Psychol Aging 2023; 38:263-276. [PMID: 37067480 PMCID: PMC10238678 DOI: 10.1037/pag0000744] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Growing evidence suggests that participation in enriching activities (physical, social, and mental) across the life course is beneficial for cognitive functioning in older age. However, few studies have examined the effects of enrichment across the entire life course within the same participants. Using 2,931 participants in the Health and Retirement Study, we linked self-report data from later life and retrospective self-report data from early life and midlife to cognitive performance after Age 65. We categorized participants as having either high (top ∼25%) or average to low (bottom ∼75%) level of enrichment during each life period. Thus, eight groups were identified that reflected unique patterns of enrichment during early, mid, and later life (e.g., high-high-high). Using growth curve modeling, we found that life course enrichment patterns predicted both cognitive functioning and the rate of cognitive decline across five time points spanning 8 years (Aim 1). Groups with high enrichment during at least one life period had higher performance and slower decline in older age, compared to those who had average to low levels of enrichment throughout all three life periods. We also found that high enrichment during each life period independently predicted better cognitive performance and that high enrichment during early and later life also predicted slower cognitive decline (Aim 2). These findings support the idea that high enrichment is beneficial for cognition in later life and that the effects are long-lasting, even when individuals are inconsistent in enrichment engagement throughout the entire life course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Jacqui Smith
- Institute for Social Research, University of Michigan
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37
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Jenson TE, Bakulski KM, Wesp L, Dookeran K, Driscoll I, Kalkbrenner AE. Racialized experience, biomarkers of lead exposure, and later-life cognition: a mediation analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.22.23288920. [PMID: 37163072 PMCID: PMC10168513 DOI: 10.1101/2023.04.22.23288920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We evaluated the role of the neurotoxicant lead (Pb) in mediating racial disparities in later-life cognition in 1,085 non-Hispanic Black and 2,839 non-Hispanic white participants in NHANES (1999-2002, 2011-2014) 60+ years of age. We operationalized Black race as a marker for the experience of racialization and exposure to systemic racism. We estimated patella bone Pb via predictive models using blood Pb and demographics. Concurrent cognition (processing speed, sustained attention, working memory) was measured by the Digit Symbol Substitution Test (DSST) and a global measure combining four cognitive tests. To obtain the portion mediated, we used regression coefficients (race on Pb * Pb on cognitive score)/(race on cognitive score), adjusting for age, NHANES cycle, and sample weights. Other confounder adjustment (education, poverty income ratio, smoking) was limited to the mediator-outcome (i.e., Pb-cognition) pathway because these factors do not lie upstream of race and so cannot confound associations with race. Pb was estimated to mediate 0.6% of the association between race and global cognition, and 4% of the DSST. Our results suggest that later-life cognitive health disparities may be impacted by avoidable lead exposure driven by environmental injustice, noting that a large proportion of the pathway of systemic racism harming cognition remains.
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Affiliation(s)
- Tara E. Jenson
- Department of Environmental Health Sciences, Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, USA
| | - Kelly M. Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Linda Wesp
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Keith Dookeran
- Department of Epidemiology, Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, USA
| | - Ira Driscoll
- Alzheimer's Disease Research Center, University of Wisconsin - Madison, Madison, WI, USA
- Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy E. Kalkbrenner
- Department of Environmental Health Sciences, Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, USA
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Rosso AL, Troxel WM, Gary-Webb TL, Weinstein AM, Butters MA, Palimaru A, Ghosh-Dastidar B, Wagner L, Nugroho A, Hunter G, Parker J, Dubowitz T. Design of the think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and alzheimer's disease risk in disinvested, black neighborhoods. BMC Public Health 2023; 23:636. [PMID: 37013498 PMCID: PMC10069058 DOI: 10.1186/s12889-023-15381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Black Americans have disproportionately higher rates and earlier onset of Alzheimer's disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans. METHODS The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35-49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life. DISCUSSION Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US.
| | - Wendy M Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US
| | | | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, US
| | - Alina Palimaru
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - La'Vette Wagner
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Alvin Nugroho
- Survey Research Group, RAND Corporation, Santa Monica, US
| | - Gerald Hunter
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - Tamara Dubowitz
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
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Lu P, Kezios K, Milazzo F, Jawadekar N, Shelley M, Zeki Al Hazzouri A. Racial Differences in Employment and Poverty Histories and Health in Older Age. Am J Prev Med 2023; 64:543-551. [PMID: 36642644 DOI: 10.1016/j.amepre.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health. METHODS Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (NBlack=555, NWhite=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022. RESULTS More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents. CONCLUSIONS Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.
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Affiliation(s)
- Peiyi Lu
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Katrina Kezios
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Floriana Milazzo
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Neal Jawadekar
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mack Shelley
- Department of Political Science, Iowa State University, Ames, Iowa; Department of Statistics, Iowa State University, Ames, Iowa
| | - Adina Zeki Al Hazzouri
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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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: 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: 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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Soh Y, Whitmer RA, Mayeda ER, Glymour MM, Peterson RL, Eng CW, Quesenberry CP, Manly JJ, Gilsanz P. State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults. JAMA Neurol 2023; 80:352-359. [PMID: 36780143 PMCID: PMC9926357 DOI: 10.1001/jamaneurol.2022.5337] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/11/2022] [Indexed: 02/14/2023]
Abstract
Importance Higher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities. Objective To evaluate the association between state-level educational quality during childhood and dementia risk. Design, Setting, and Participants This cohort study analyzed longitudinal data collected from January 1, 1997, through December 31, 2019 (23-year follow-up period). The sample comprised members of Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, who completed an optional survey during 1964-1972. Eligible individuals were US born; non-Hispanic Black or non-Hispanic White; aged 65 years or older as of January 1, 1996; were still alive; and did not have a dementia diagnosis or lapse in KPNC membership greater than 90 days between January 1 and December 31, 1996. Exposures Historical state-level administrative indicators of school quality (school term length, student-teacher ratio, and attendance rates) linked to participants using birth state and birth year (with a 6-year lag) and divided into tertiles using the pooled sample. Main Outcomes and Measures Dementia diagnoses from electronic health records between 1997 and 2019 were analyzed between March 1 and August 31, 2022. The associations of educational quality with incident dementia were estimated using Cox proportional hazards regression models. Results Among 21 450 KPNC members who participated in the optional survey, individuals born before availability of educational quality records (n = 87) and missing educational attainment (n = 585) were excluded. The final analytic sample was 20 778 individuals (56.5% women, 43.5% men; mean [SD] age, 74.7 [6.5] years; 18.8% Black; 81.2% White; 41.0% with less than high school education). Among Black individuals, 76.2% to 86.1% (vs 20.8%-23.3% of White individuals) attended schools in states in the lowest educational quality tertiles. Highest (vs lowest) educational quality tertiles were associated with lower dementia risk (student-teacher ratio: hazard ratio [HR], 0.88 [95% CI, 0.83-0.94]; attendance rates: HR, 0.80 [95% CI, 0.73-0.88]; term length: HR, 0.79 [95% CI, 0.73-0.86]). Effect estimates did not differ by race and were not attenuated by adjustment for educational attainment. Conclusions and Relevance In this cohort study, lower state-average educational quality was more common among Black individuals and associated with higher dementia risk. Differential investment in high-quality education due to structural racism may contribute to dementia disparities.
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Affiliation(s)
- Yenee Soh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California, Davis
- Department of Neurology, School of Medicine, University of California, Davis
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Rachel L. Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Chloe W. Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | | | - 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 Irving Medical Center, New York, New York
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Seblova D, Eng C, Avila‐Rieger JF, Dworkin JD, Peters K, Lapham S, Zahodne LB, Chapman B, Prescott CA, Gruenewald TL, Arpawong TE, Gatz M, Jones RJ, Glymour MM, Manly JJ. High school quality is associated with cognition 58 years later. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12424. [PMID: 37144175 PMCID: PMC10152568 DOI: 10.1002/dad2.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/16/2022] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
Abstract
We leveraged a unique school-based longitudinal cohort-the Project Talent Aging Study-to examine whether attending higher quality schools is associated with cognitive performance among older adults in the United States (mean age = 74.8). Participants (n = 2,289) completed telephone neurocognitive testing. Six indicators of high school quality, reported by principals at the time of schooling, were predictors of respondents' cognitive function 58 years later. To account for school-clustering, multilevel linear and logistic models were applied. We found that attending schools with a higher number of teachers with graduate training was the clearest predictor of later-life cognition, and school quality mattered especially for language abilities. Importantly, Black respondents (n = 239; 10.5 percentage) were disproportionately exposed to low quality high schools. Therefore, increased investment in schools, especially those that serve Black children, could be a powerful strategy to improve later life cognitive health among older adults in the United States.
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Affiliation(s)
- Dominika Seblova
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
- Second Faculty of MedicineCharles University PraguePragueCzech Republic
| | - Chloe Eng
- University of California San FranciscoDepartment of Epidemiology and BiostatisticsSan FranciscoCaliforniaUSA
| | - Justina F. Avila‐Rieger
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | | | - Kelly Peters
- American Institutes for ResearchWashingtonDistrict of ColumbiaUSA
| | - Susan Lapham
- American Institutes for ResearchWashingtonDistrict of ColumbiaUSA
| | | | | | | | | | | | - Margaret Gatz
- University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Rich J. Jones
- Brown UniversityDepartment of Psychiatry and Human Behavior & Department of NeurologyProvidenceRhode IslandUSA
| | - Maria M. Glymour
- University of California San FranciscoDepartment of Epidemiology and BiostatisticsSan FranciscoCaliforniaUSA
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
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Aranda MP, Marquez DX, Gallagher‐Thompson D, Pérez A, Rojas JC, Hill CV, Reyes Y, Dilworth‐Anderson P, Portacolone E. A call to address structural barriers to Hispanic/Latino representation in clinical trials on Alzheimer's disease and related dementias: A micro-meso-macro perspective. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12389. [PMID: 37287471 PMCID: PMC10242183 DOI: 10.1002/trc2.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/09/2023]
Abstract
Introduction This perspective paper addresses the US Hispanic/Latino (herein, Latino) experience with regards to a significant public health concern-the underrepresentation of Latino persons in Alzheimer's disease and related dementias (AD/ADRD) clinical trials. Latino individuals are at increased risk for AD/ADRD, experience higher disease burden, and low receipt of care and services. We present a novel theoretical framework-the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment-which considers multi-level barriers and their impact on Latino trial recruitment. Methods Based on a review of the peer-reviewed literature and our lived experience with the Latino community, we drew from our interdisciplinary expertise in health equity and disparities research, Latino studies, social work, nursing, political economy, medicine, public health, and clinical AD/ADRD trials. We discuss factors likely to impede or accelerate Latino representation, and end with a call for action and recommendations for a bold path forward. Results In the 200+ clinical trials conducted with over 70,000 US Americans, Latino participants comprise a fraction of AD/ADRD trial samples. Efforts to recruit Latino participants typically address individual- and family-level factors (micro-level) such as language, cultural beliefs, knowledge of aging and memory loss, limited awareness of research, and logistical considerations. Scientific efforts to understand recruitment barriers largely remain at this level, resulting in diminished attention to upstream institutional- and policy-level barriers, where decisions around scientific policies and funding allocations are ultimately made. These structural barriers are comprised of inadequacies or misalignments in trial budgets, study protocols, workforce competencies, healthcare-related barriers, criteria for reviewing and approving clinical trial funding, criteria for disseminating findings, etiological focus and social determinants of health, among others. Conclusion Future scientific work should apply and test the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment to examine structural recruitment barriers for historically underrepresented groups in AD/ADRD research and care.
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Affiliation(s)
- María P. Aranda
- University of Southern CaliforniaAlzheimer's Disease Research CenterLos AngelesCaliforniaUSA
- USC Suzanne Dworak‐Peck School of Social WorkEdward R. Roybal Institute on AgingUniversity of Southern CaliforniaUSC Montgomery Ross Fisher BuildingLos AngelesCaliforniaUSA
| | - David X. Marquez
- Department of Kinesiology and NutritionUniversity of Illinois ChicagoChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterChicagoIllinoisUSA
| | - Dolores Gallagher‐Thompson
- Department of Psychiatry & Behavioral SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Adriana Pérez
- Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Julio C. Rojas
- Memory and Aging CenterUCSF Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoMemory and Aging CenterSan FranciscoCaliforniaUSA
| | - Carl V. Hill
- Chief of DiversityEquity and InclusionAlzheimer's AssociationChicagoIllinoisUSA
| | - Yarissa Reyes
- Director of DiversityEquity and InclusionAlzheimer's AssociationChicagoIllinoisUSA
| | - Peggye Dilworth‐Anderson
- Health Policy and ManagementGillings School of Global Public Health1104 D McGavran Greenberg, University of North Carolina—Chapel HillNorth CarolinaUSA
| | - Elena Portacolone
- Institute for Health and AgingUniversity of California San FranciscoPhilip Lee Institute for Health Policy StudiesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Carr DC, Reynolds J. Race-Discordant School Attendance and Cognitive Function in Later Life. Res Aging 2023; 45:320-331. [PMID: 35607792 DOI: 10.1177/01640275221103791] [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] [Indexed: 11/15/2022]
Abstract
Early schooling plays an important role in shaping cognitive development. This study explored benefits of cognitive functioning in later life related to attending diverse schools in early life. Specifically, we explored the effects of having attended schools composed primarily of different race peers-race discordant schools (RDS)-among Black and White older adults. Using retrospective and prospective data from the Health and Retirement Study, we examined the association between RDS exposure and two measures of cognitive function (working memory, episodic memory) at age 55 and at age 70. We found that RDS exposed Blacks experienced significant benefits in cognitive function at age 55 and at age 70. In general, RDS exposed Whites did not experience cognitive benefits or deficits. Results suggest that exposure to more racially diverse school environments provides potentially beneficial effects for cognitive function, particularly in later phases of the life course.
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Affiliation(s)
- Dawn C Carr
- Department of Sociology, 7823Florida State University, Tallahassee, FL, USA
| | - John Reynolds
- Department of Sociology, 7823Florida State University, Tallahassee, FL, USA
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Dinh PTT, Robinson JA. Persistence and fading of the cognitive and socio-emotional benefits of preschool education in a low-resource setting: Group differences and dose-dependent associations in longitudinal data from Vietnam. Front Psychol 2023; 14:1065572. [PMID: 36824306 PMCID: PMC9942945 DOI: 10.3389/fpsyg.2023.1065572] [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: 10/09/2022] [Accepted: 01/06/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Four analytic approaches examined the effectiveness of preschool education in Vietnam, which provides a context in which national curricula and teaching standards for preschools and schools, high levels of preschool attendance, and fee subsidies for disadvantaged children, limit the heterogeneity in children's experiences that often obscure the outcomes associated with preschool attendance. Methods The Young Lives Study provided longitudinal data on children's receptive vocabulary, mathematics, and life satisfaction at 5, 8, 12, and 15 years of age, and on their self-concept and relationships at 12 and 15 years. Results The first analysis found that children who attended preschool (n = 1,562 at 5 years of age) had larger vocabularies at 5, 8, 12, and 15 years, greater mathematics knowledge at 5, 8, and 12 years, and higher life satisfaction at 5 and 12 years of age than the small number of children who did not attend preschool (n = 164 at 5 years of age). The second, found that the dose of preschool education (hours per week × 4 × months) received by children who attended preschool was positively associated with their receptive vocabulary and mathematics scores at 5, 8, 12, and 15 years of age, and with their life satisfaction at 5 and 15 years of age. Although the magnitude of the effect for vocabulary declined over time, it remained stable for mathematics. The third analysis found that a high dose of preschool education allowed disadvantaged rural children to achieve comparable or better scores than their urban peers for receptive vocabulary at 8, 12, and 15 years, mathematics at 12 years, and life satisfaction at all ages. The final analysis found that even a low dose of preschool education improved rural children's receptive vocabulary at 5, 8, and 15 years, and their numeracy/mathematics scores at 5, 8, and 12 years. Discussion Together, the results suggest that preschool attendance had a small but meaningful positive association with Vietnamese children's cognitive skills and life satisfaction that persisted for at least 10 years. These findings provide insights into the scale, scope, and longevity of effects that can be achieved from scaled-up preschool programs under resource-constrained conditions.
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Affiliation(s)
- Phuong Thi Thu Dinh
- College of Education, Hue University, Hue, Vietnam,Kinder in Wien, Vienna, Austria,*Correspondence: Phuong Thi Thu Dinh,
| | - Julie Ann Robinson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Kociolek AJ, Fernandez KK, Hernandez M, Jin Z, Cosentino S, Zhu CW, Gu Y, Devanand DP, Stern Y. Neuropsychiatric Symptoms and Trajectories of Dependence and Cognition in a Sample of Community-dwelling Older Adults with Dementia. Curr Alzheimer Res 2023; 20:409-419. [PMID: 37694796 PMCID: PMC10726418 DOI: 10.2174/1567205020666230908163414] [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: 01/04/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropsychiatric symptoms (NPS), including psychotic symptoms (hallucinations, illusions, delusions), agitation/aggression, and depressed mood, are common in individuals with Alzheimer's disease (AD) and predict poorer outcomes, including faster disease progression. We aimed to evaluate associations between NPS and cognition and dependence in a multi-ethnic sample of community-dwelling older adults with AD. METHODS Predictors 3 (P3) is a cohort study of AD disease courses recruiting older adults aged 65 and above residing in upper Manhattan. A total of 138 of 293 participants had probable AD at the study baseline. We fit linear mixed models to examine longitudinal associations of time-varying NPS (psychotic symptoms, agitation/aggression, and depressed mood) with dependence and cognition, adjusted for race-ethnicity, sex, education, age, clinical dementia rating score, APOE-ε4, and comorbidity burden; separate interaction models were fit for age, Hispanic ethnicity, and sex. RESULTS Psychotic symptoms were associated with faster rates of increasing dependence and declining cognition over time, agitation/aggression with faster rates of declining cognition, and depressed mood with faster rates of increasing dependence. Among psychotic symptoms, delusions, but not hallucinations or illusions, were associated with worse outcome trajectories. Depressed mood predicted an accelerated increase in dependence in males but not females. CONCLUSION Our results confirm and extend prior results in clinic-based samples. The presence of NPS was associated with worse trajectories of dependence and cognition in this muti-ethnic sample of older adults with AD. Importantly, sex modified the association between depressed mood and dependence. Our results on NPS as predictors of differential AD progression in a community-dwelling, ethnically diverse sample serve to better inform the clinical care of patients and the future development of AD therapies.
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Affiliation(s)
- Anton J. Kociolek
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michelle Hernandez
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Carolyn W. Zhu
- Brookdale Department of Geriatrics & Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Davangere P. Devanand
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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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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Dobbins S, Hubbard E, Leutwyler H. Education Mediates Racial Disparities in Cognitive Impairment Among Older Adults With Schizophrenia. Clin Gerontol 2023; 46:66-79. [PMID: 33579181 PMCID: PMC8610378 DOI: 10.1080/07317115.2021.1882021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia. METHODS We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our "all-comer" sample (N = 64). The primary exposure is self-reported racial group. We examine mediation of cognitive impairment through educational attainment, adjusting for psychiatric illness severity, history of substance use, and vascular risk factors. RESULTS There was a Black/non-Black group racial disparity in global cognitive score (-2.8, 95% CI: -4.4, -1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education. CONCLUSIONS There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education. CLINICAL IMPLICATIONS Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia. ABBREVIATIONS CDE Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia.
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Affiliation(s)
- Sarah Dobbins
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Erin Hubbard
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Heather Leutwyler
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
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Fletcher E. Multifactorial Modeling of Cognitive Trajectories Using an Advanced Regression Technique: Improving Our Understanding of Biomarkers and Modifiable Variables that Support Cognition. J Alzheimers Dis 2023; 93:815-819. [PMID: 37212065 DOI: 10.3233/jad-230304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Current research trends emphasize complex models of cognitive outcomes, with multiple, interacting predictors, including factors amenable to interventions toward sustaining healthy cognitive aging. Such models often require advanced analysis techniques. The article by Stark et al., 'Partial least squares regression analysis of Alzheimer's disease biomarkers, modifiable health variables, and cognitive change in older adults with mild cognitive impairment', uses partial least squares regression to examine the associations to memory and executive change of 29 biomarker and demographic variables. This commentary discusses the significance of their results and methods within the context of current research foci.
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Affiliation(s)
- Evan Fletcher
- Department of Neurology, Imaging of Dementia and Aging (IDeA) Laboratory, University of California, Davis, Davis, CA, USA
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O’Shea DM, Galvin JE. Female APOE ɛ4 Carriers with Slow Rates of Biological Aging Have Better Memory Performances Compared to Female ɛ4 Carriers with Accelerated Aging. J Alzheimers Dis 2023; 92:1269-1282. [PMID: 36872781 PMCID: PMC10535361 DOI: 10.3233/jad-221145] [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: 03/06/2023]
Abstract
BACKGROUND Evidence suggests that APOE ɛ4 carriers have worse memory performances compared to APOE ɛ4 non-carriers and effects may vary by sex and age. Estimates of biological age, using DNA methylation may enhance understanding of the associations between sex and APOE ɛ4 on cognition. OBJECTIVE To investigate whether associations between APOE ɛ4 status and memory vary according to rates of biological aging, using a DNA methylation age biomarker, in older men and women without dementia. METHODS Data were obtained from 1,771 adults enrolled in the 2016 wave of the Health and Retirement Study. A series of ANCOVAs were used to test the interaction effects of APOE ɛ4 status and aging rates (defined as 1 standard deviation below (i.e., slow rate), or above (i.e., fast rate) their sex-specific mean rate of aging on a composite measure of verbal learning and memory. RESULTS APOE ɛ4 female carriers with slow rates of GrimAge had significantly better memory performances compared to fast and average aging APOE ɛ4 female carriers. There was no effect of aging group rate on memory in the female non-carriers and no significant differences in memory according to age rate in either male APOE ɛ4 carriers or non-carriers. CONCLUSION Slower rates of aging in female APOE ɛ4 carriers may buffer against the negative effects of the ɛ4 allele on memory. However, longitudinal studies with larger sample sizes are needed to evaluate risk of dementia/memory impairment based on rates of aging in female APOE ɛ4 carriers.
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Affiliation(s)
- Deirdre M. O’Shea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
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