The Independent and Interactive Associations of Bilingualism and Sex on Cognitive Performance in Hispanics/Latinos of the Hispanic Community Health Study/Study of Latinos

Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV

Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.

Dual-Language Use and Cognitive Function Among Mexican Americans Aged 65 and Older

Background

Better English proficiency and higher frequency of using English among non-native speakers are associated with lower dementia risk.

Objective

We investigated if Mexican American older adults who use English and Spanish to a more similar degree demonstrate better cognitive function than those who use one language more than the other.

Methods

We used data from waves one (1992/93) to eight (2012/13) of the Hispanic Established Population for the Epidemiological Study of the Elderly. At baseline, participants were asked what language they usually use across communicative contexts. We based dual language on participants' use of Spanish and English within and across contexts. We categorized participants as low (n = 1,145), medium (n = 717), and high (n = 702) dual-language users. Linear mixed models were used to estimate the association between dual-language use, baseline Mini-Mental State Examination (MMSE) scores, and change in MMSE.

Results

Participants in the medium and high dual-language use categories scored 1.91 points and 3.03 points higher at wave one compared to the low dual-language use category. Adjusting for education reduced the association between dual-language use and baseline MMSE (medium B = 0.99 SE = 0.19 p < 0.01; high B = 1.41 SE = 0.21 p < 0.01). The association between dual-language use and decline in the MMSE was not statistically significant.

Conclusions

Greater dual-language use was associated with higher MMSE scores but not change in MMSE scores among Mexican Americans aged 65 and older. Future work should characterize bilingualism with greater nuance and use more rigorous cognitive measures to identify the components of the bilingual experience that may benefit the cognitive functioning of older adult bilinguals.

The Spanish-English bilingual experience and cognitive change in Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging

INTRODUCTION

Studies suggest bilingualism may delay behavioral manifestations of adverse cognitive aging including Alzheimer's dementia.

METHODS

Three thousand nine hundred sixty-three participants (unweighted mean population age ≈56 years) at Hispanic Community Health Study/Study of Latinos baseline (2008-2011) self-reported their and their parents' birth outside the United States, Spanish as their first language, and used Spanish for baseline and comparable cognitive testing 7 years later (2015-2018). Spanish/English language proficiency and patterns of use were self-rated from 1 = only Spanish to 4 = English > Spanish. Cognitive testing included test-specific and global composite score(s) of verbal learning, memory, word fluency, and Digit Symbol Substitution (DSS). Survey linear regression models examined associations between baseline bilingualism scores and cognition.

RESULTS

Higher second-language (English) proficiency and use were associated with higher global cognition, fluency, and DSS at follow-up and better than predicted change in fluency.

DISCUSSION

The bilingual experience was more consistently related to 7-year level versus change in cognition for Hispanics/Latinos.

Normative data for the Brief Spanish-English Verbal Learning Test for representative and diverse Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

INTRODUCTION

Episodic learning and memory performance are crucial components of cognitive assessment. To meet the needs of a diverse Hispanic/Latino population, we aimed to provide normative data on the Brief Spanish-English Verbal Learning Test (B-SEVLT).

METHODS

The target population for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) included individuals 45+ years old from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds. Average age was 56.5 years ± 9.92, 54.5% were female, and mean education was 11.0 years ± 5.6 (unweighted n = 9309). Participants were administered the B-SEVLT in their preferred language (Spanish or English). Hispanic/Latino background adjusted B-SEVLT scores and percentile cut-points were created using survey-adjusted regression models.

RESULTS

Higher educational attainment, younger age, and being female were associated with higher learning and memory performance. Hispanic/Latino background groups differed in B-SEVLT performance.

DISCUSSION

Representative learning and memory norms for Hispanic/Latinos of diverse backgrounds will improve cognitive assessment and accuracy of neurocognitive disorder diagnosis.

MIND Diet and Cognitive Function over Eight Years in Puerto Rican Older Adults

BACKGROUND

Healthy diets have been associated with better cognitive function. Socio-economic factors including education, poverty and job complexity may modify the relationship between diet and cognition.

METHODS

We used adjusted linear mixed models to examine the association between long-term adherence to the Mediterranean-Dietary Approaches to Stop Hypertension - Intervention for Neurodegenerative Delay (MIND) diet and cognitive function over 8 years of follow-up in Puerto Rican adults residing in the Boston, MA area (aged 45 to 75 years at baseline). We also examined whether the MIND diet - cognition association was confounded or modified by socioeconomic measures.

RESULTS

In both cross-sectional and longitudinal analyses the highest, vs lowest, MIND quintile was associated with better cognition function (ß = 0.093; 95% CI: 0.035, 0.152; P trend = 0.0019), but not with cognitive trajectory over 8 years. Education <=8 th grade (ß = -0.339; 95% CI: 0.394, -0.286; P < 0.0001) and income-to-poverty ratio <120% (ß = -0.049; 95% CI: -0.092, -0.007; P = 0.024) were significantly associated with lower cognitive function, while higher job complexity (ß = 0.008; 95% CI: 0.006, 0.011; P < 0.0001) was associated with better cognition function. These variables acted confounders, but not effect modifiers of the MIND-diet - cognitive function relationship.

CONCLUSION

Adherence to the MIND diet was associated with better cognitive function at baseline and over 8 years of follow-up, however MIND diet was not associated with 8-year cognitive trajectory. More studies are needed to better understand whether the MIND diet is protective against long-term cognitive decline.

Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors

BACKGROUND

Cognitively-defined subgroups are well-documented within neurodegeneration.

OBJECTIVE

We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration.

METHODS

121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, 'animal' fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders.

RESULTS

Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001).

CONCLUSION

LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.

Testing measurement equivalence of neurocognitive assessments across language in the Hispanic Community Health Study/Study of Latinos

OBJECTIVE

Neuropsychological instruments are often developed in English and translated to other languages to facilitate the clinical evaluation of diverse populations or to utilize in research environments. However, the psychometric equivalence of these assessments across language must be demonstrated before populations can validly be compared.

METHOD

To test this equivalence, we applied measurement invariance procedures to a subsample (N = 1,708) of the Hispanic Community Health Survey/Study of Latinos (HCHS/SOL) across English and Spanish versions of a neurocognitive battery. Using cardinality matching, 854 English-speaking and 854 Spanish-speaking subsamples were matched on age, education, sex, immigration status (U.S. born, including territories, or foreign-born), and Hispanic/Latino heritage background. Neurocognitive measures included the Six-Item Screener (SIS), Brief-Spanish English Verbal Learning Test (B-SEVLT), Word Fluency (WF), and Digit Symbol Substitution (DSS). Confirmatory factor analysis was utilized to test item-level invariance of the SIS, B-SEVLT, and WF, as well as factor-level invariance of a higher-order neurocognitive functioning latent variable.

RESULTS

One item of both the SIS and WF were more difficult in Spanish than English, as was the DSS test. After accounting for partial invariance, Spanish-speakers performed worse on each of the subtests and the second-order neurocognitive functioning latent variable.

CONCLUSIONS

We found some evidence of bias at both item and factor levels, contributing to the poorer neurocognitive performance of Spanish test-takers. While these results explain the underperformance of Spanish-speakers to some extent, more work is needed to determine whether such bias is reflective of true cognitive differences or additional variables unaccounted for in this study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychosocial Factors Associated with Cognitive Function Among Middle-Aged and Older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos and its Sociocultural Ancillary Study

BACKGROUND

Evidence suggests that psychosocial factors are associated with cognitive health in older adults; however, associations of psychosocial factors with cognition remain largely unexamined in middle-aged and older Hispanics/Latinos.

OBJECTIVE

To examine the cross-sectional associations of psychosocial factors with cognitive function among middle-aged and older Hispanics/Latinos living in the US.

METHODS

Baseline (2008-2011) data from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 2,818; ages 45-74) were used to examine the associations of each psychosocial factor with global cognition (GC), verbal learning, verbal memory, verbal fluency, and processing speed independent of age, sex, education, Hispanic/Latino background, income, language, and depressive symptoms. Psychosocial variables included: intrapersonal factors (ethnic identity, optimism, and purpose in life), interpersonal factors (family cohesion, familism, social network embeddedness, and social support), and social stressors (perceived ethnic discrimination, loneliness, and subjective social status).

RESULTS

In fully-adjusted models, purpose in life and social support were each positively associated with all five cognitive variables. Loneliness was negatively associated with GC, verbal learning, memory, and processing speed. Ethnic identity was positively and familism negatively associated with GC, verbal fluency, and processing speed. Family cohesion was positively associated with verbal learning.

CONCLUSION

These findings extend previous evidence from older, largely non-Hispanic White cohorts to show that higher purpose in life and social support are also strongly associated with cognitive health among middle-aged and older Hispanics/Latinos. We also highlight that intrapersonal factors, interpersonal factors, and social stressors have differential relationships with individual cognitive tests.

Vascular contributions to cognitive impairment and dementia (VCID): A report from the 2018 National Heart, Lung, and Blood Institute and National Institute of Neurological Disorders and Stroke Workshop

Vascular contributions to cognitive impairment and dementia (VCID) are characterized by the aging neurovascular unit being confronted with and failing to cope with biological insults due to systemic and cerebral vascular disease, proteinopathy including Alzheimer's biology, metabolic disease, or immune response, resulting in cognitive decline. This report summarizes the discussion and recommendations from a working group convened by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke to evaluate the state of the field in VCID research, identify research priorities, and foster collaborations. As discussed in this report, advances in understanding the biological mechanisms of VCID across the wide spectrum of pathologies, chronic systemic comorbidities, and other risk factors may lead to potential prevention and new treatment strategies to decrease the burden of dementia. Better understanding of the social determinants of health that affect risks for both vascular disease and VCID could provide insight into strategies to reduce racial and ethnic disparities in VCID.

Racial Differences in Dietary Relations to Cognitive Decline and Alzheimer's Disease Risk: Do We Know Enough?

The elderly population in the US is increasing and projected to be 44% minority by 2060. African Americans and Hispanics are at increased risk of cognitive impairment and Alzheimer’s disease compared to non-Hispanic whites. These conditions are associated with many other adverse health outcomes, lower quality of life, and substantial economic burden. In the past few decades, diet has been identified as an important modifiable risk factor for cognitive decline and Alzheimer’s disease. Some studies report poor diet quality among African American and Hispanic older adult populations compared to their white counterparts. We have a limited understanding of how diet affects brain health in different racial-ethnic groups. One primary reason for our lack of knowledge is that most cohort studies are of majority non-Hispanic white participants. Moreover, those that do include minority participants do not publish their findings stratified by racial-ethnic groups, and likely have a less accurate measurement of dietary intake among minority groups. In this review, we summarize the current, albeit limited, literature on racial/ethnic differences in dietary relations to dementia outcomes. We will also discuss methodological issues in conducting nutrition studies in diverse cultures, and suggestions for future research directions. Overcoming the gaps will make it possible to make dietary recommendations for Alzheimer’s prevention that are more relevant for different racial/ethnic groups and set us on a faster track to reduce health disparities.