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Lane JM, Zimmer A, Quiñones-Cordero MM, Sörensen S. Racial differences in the effect of verbal and nonverbal memory on concrete planning for future care needs among older adults: a multi-group structural equation modeling approach. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:587-604. [PMID: 37317954 PMCID: PMC10721738 DOI: 10.1080/13825585.2023.2223902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
Concrete planning for future care needs may positively impact older adults' subsequent mental health and quality of life. However, the cognitive factors that facilitate concrete planning among Black and White older adults are still poorly understood. We investigated whether there are significant differences between Black (n = 159) and White (n = 262) older adults in concrete planning and explored racial differences in the relationship between verbal and nonverbal episodic memory and concrete planning. Results revealed that Blacks showed lower engagement in concrete planning and lower scores than Whites on each verbal and nonverbal memory task. For Blacks, but not Whites, verbal memory and nonverbal memory performance predicted concrete planning with higher nonverbal memory relating to less concrete planning and higher verbal memory associated with more concrete planning. Our findings suggest racial differences exist in how episodic verbal and nonverbal memory affect concrete planning, a crucial factor for older adults' preparation for future care.
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Affiliation(s)
- Jamil M Lane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alexis Zimmer
- Department of Counseling and Human Development, University of Rochester, Rochester, USA
| | - Maria M Quiñones-Cordero
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, NY, USA
| | - Silvia Sörensen
- Department of Counseling and Human Development, University of Rochester, Rochester, USA
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Niu Z, Haley AP, Clark AL, Duarte A. Age exacerbates the negative effect of depression on executive functioning in racial and ethnic minorities. Brain Imaging Behav 2024:10.1007/s11682-024-00898-3. [PMID: 38850388 DOI: 10.1007/s11682-024-00898-3] [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] [Accepted: 05/15/2024] [Indexed: 06/10/2024]
Abstract
Age and depression may interact to produce a "double jeopardy" for cognitive impairment, and executive functioning, in cognitively unimpaired aging. Few studies have considered middle age or the ethnoracial diversity of subjects, despite evidence of more severe cognitive outcomes in historically minoritized people. In this pilot study, we investigated the impact of age on depression-related cognitive impairment and the underlying brain volumes in middle-aged non-Hispanic White adults (116), and Hispanic and Black adults (60), with a total number of 176 adults. The result shows a significant interaction between age and depression for executive functioning, specifically for middle-aged Hispanic and Black adults, but not non-Hispanic White adults. Prefrontal cortex volumes, which were reduced in the Black and Hispanic compared to the non-Hispanic White adults, partially mediated the relationship between depression level and executive functioning, across age and ethnoracial group. Collectively, these results suggest that the negative impact of depression on executive functioning and Prefrontal cortex volumes integrity may be exacerbated by age and that historically minoritized people may be particularly sensitive to this double jeopardy.
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Affiliation(s)
- Zhimei Niu
- Department of Psychology, University of Texas at Austin, 108 Dean Keeton Street, Austin, TX, 78712, USA.
| | - Andreana P Haley
- Department of Psychology, University of Texas at Austin, 108 Dean Keeton Street, Austin, TX, 78712, USA
| | - Alexandra L Clark
- Department of Psychology, University of Texas at Austin, 108 Dean Keeton Street, Austin, TX, 78712, USA
| | - Audrey Duarte
- Department of Psychology, University of Texas at Austin, 108 Dean Keeton Street, Austin, TX, 78712, USA
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Chen S, Nagel CL, Liu R, Botoseneanu A, Allore HG, Newsom JT, Thielke S, Kaye J, Quiñones AR. Mental-somatic multimorbidity in trajectories of cognitive function for middle-aged and older adults. PLoS One 2024; 19:e0303599. [PMID: 38743678 PMCID: PMC11093294 DOI: 10.1371/journal.pone.0303599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Multimorbidity may confer higher risk for cognitive decline than any single constituent disease. This study aims to identify distinct trajectories of cognitive impairment probability among middle-aged and older adults, and to assess the effect of changes in mental-somatic multimorbidity on these distinct trajectories. METHODS Data from the Health and Retirement Study (1998-2016) were employed to estimate group-based trajectory models identifying distinct trajectories of cognitive impairment probability. Four time-varying mental-somatic multimorbidity combinations (somatic, stroke, depressive, stroke and depressive) were examined for their association with observed trajectories of cognitive impairment probability with age. Multinomial logistic regression analysis was conducted to quantify the association of sociodemographic and health-related factors with trajectory group membership. RESULTS Respondents (N = 20,070) had a mean age of 61.0 years (SD = 8.7) at baseline. Three distinct cognitive trajectories were identified using group-based trajectory modelling: (1) Low risk with late-life increase (62.6%), (2) Low initial risk with rapid increase (25.7%), and (3) High risk (11.7%). For adults following along Low risk with late-life increase, the odds of cognitive impairment for stroke and depressive multimorbidity (OR:3.92, 95%CI:2.91,5.28) were nearly two times higher than either stroke multimorbidity (OR:2.06, 95%CI:1.75,2.43) or depressive multimorbidity (OR:2.03, 95%CI:1.71,2.41). The odds of cognitive impairment for stroke and depressive multimorbidity in Low initial risk with rapid increase or High risk (OR:4.31, 95%CI:3.50,5.31; OR:3.43, 95%CI:2.07,5.66, respectively) were moderately higher than stroke multimorbidity (OR:2.71, 95%CI:2.35, 3.13; OR: 3.23, 95%CI:2.16, 4.81, respectively). In the multinomial logistic regression model, non-Hispanic Black and Hispanic respondents had higher odds of being in Low initial risk with rapid increase and High risk relative to non-Hispanic White adults. CONCLUSIONS These findings show that depressive and stroke multimorbidity combinations have the greatest association with rapid cognitive declines and their prevention may postpone these declines, especially in socially disadvantaged and minoritized groups.
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Affiliation(s)
- Siting Chen
- OHSU-PSU School of Public Health, Portland, Oregon, United States of America
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ruotong Liu
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heather G. Allore
- Department of Internal Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Biostatistics, Yale University, New Haven, Connecticut, United States of America
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, Oregon, United States of America
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ana R. Quiñones
- OHSU-PSU School of Public Health, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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Bayram E, Banks SJ. Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease. Clin Neuropsychol 2024:1-22. [PMID: 38741341 DOI: 10.1080/13854046.2024.2350096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Korinek K, Zimmer Z, Teerawichitchainan B, Young Y, Cao Manh L, Toan TK. Cognitive function following early life war-time stress exposure in a cohort of Vietnamese older adults. Soc Sci Med 2024; 349:116800. [PMID: 38640743 PMCID: PMC11105098 DOI: 10.1016/j.socscimed.2024.116800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/22/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024]
Abstract
Although Alzheimer's Disease is a leading cause of death in Vietnam and other post-conflict, low- and middle-income countries, aside from studies of veterans in western populations, research on war-related violence and deprivation as risk factors for cognitive disorders remains sparse. Using data from the Vietnam Health and Aging Study, which relied upon a multistage probability sample of 2447 older adults residing in districts of northern Vietnam differentially exposed to wartime bombing and numerous war-related stressors, this paper investigates associations between early-life war-related stressors and later-life cognitive function in a cohort whose transition to adulthood took place during the American-Vietnam War. Relationships among experiences of severe childhood hunger, war-related violence and environmental hardships, military service, and cognitive function in an analytical sample of 2162 Vietnamese older adults are estimated using quantile regression. Cognitive function is assessed by a modified Mini-Mental State Examination (MMSE) score. Analyses also address posttraumatic stress disorder (PTSD), cardiovascular health, and health behaviors as potential mediators between early life war-related stressors and current cognitive function. Results indicate that experiences of severe hunger in childhood and environmental hardships are associated with poorer cognitive function in older adulthood. PTSD, cardiovascular risk (i.e., hypertension) and disease (i.e., stroke), each of which is heightened by exposure to wartime stressors, are associated with lower cognitive scores. Results suggest that certain war exposures, like involvement in combat duties, are associated with higher cognitive function scores, suggesting that military service either positively selects for cognitive function, or certain forms of service may impart cognitive resilience. Following recent calls to incorporate population-specific stressors to advance explanatory models of cognitive function, these findings suggest that it is critical to assess the enduring scars and resilience of armed conflict in global efforts to understand, prevent, and treat cognitive impairment, Alzheimer's Disease, and related dementias.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, USA.
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Canada
| | | | - Yvette Young
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Long Cao Manh
- Family Medicine Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Tran Khanh Toan
- Family Medicine Department, Hanoi Medical University, Hanoi, Viet Nam
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Holleman J, Kåreholt I, Aspö M, Hagman G, Udeh-Momoh CT, Kivipelto M, Solomon A, Sindi S. Life-course stress, cognition, and diurnal cortisol in memory clinic patients without dementia. Arch Gerontol Geriatr 2024; 119:105316. [PMID: 38134708 DOI: 10.1016/j.archger.2023.105316] [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: 09/13/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
AIMS To examine associations of life-course stress with cognition and diurnal cortisol patterns in older adulthood, as well as potential mediation effects of diurnal cortisol patterns and perceived stress on the association between life-course stress and cognition. METHODS 127 participants without dementia were selected from a cohort of Swedish memory clinic patients. Cross-sectional associations between scores on two chronic stress questionnaires (perceived stress, stressful life events (SLEs)), five cognitive domains (overall cognition, memory, working memory, processing speed, perceptual reasoning), and two measures of diurnal cortisol patterns (total daily output, diurnal cortisol slope), as well as potential mediation effects of diurnal cortisol patterns and perceived stress on associations between life-course stress and cognition, were assessed using linear regressions. RESULTS Greater lifetime exposure to SLEs was associated with worse memory, working memory, and processing speed performance, but not with diurnal cortisol patterns. A greater number of SLEs in late childhood was associated with worse working memory and processing speed, while a greater number of SLEs in non-recent adulthood were associated with better overall cognition and perceptual reasoning. Greater perceived stress was associated with a flattened diurnal cortisol slope, but not with cognition. No evidence for interplay between self-reported and physiological stress markers was found in relation to cognition, although there appeared to be a significant positive indirect association between economic/legal SLEs and the diurnal cortisol slope via perceived stress. CONCLUSIONS The associations between SLEs and cognition depend on the period during which SLEs occur, but seem independent of late-life cortisol dysregulation.
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Affiliation(s)
- Jasper Holleman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden.
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; School of Health and Welfare, Aging Research Network -Jönköping (ARN-J), Institute of Gerontology, Jönköping University, Jönköping, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Hagman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Chinedu T Udeh-Momoh
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK; Global Brain Health Institute, University of California San Francisco, USA; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK
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Zuelsdorff M, Sonnega A, Barnes LL, Byrd DR, Rose DK, Cox R, Norton D, Turner RW. Childhood and Adulthood Trauma Associate With Cognitive Aging Among Black and White Older Adults. Am J Geriatr Psychiatry 2024; 32:373-385. [PMID: 38288940 PMCID: PMC10922107 DOI: 10.1016/j.jagp.2023.09.015] [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: 05/11/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 02/23/2024]
Abstract
Sociocontextual factors powerfully shape risk for age-related cognitive impairment, including excess risk burdening medically underserved populations. Lifecourse adversity associates with cognitive aging, but harms are likely mitigable. Understanding population-salient relationships and sensitive periods for exposure is crucial for targeting clinical interventions. OBJECTIVE The authors examined childhood and adulthood traumatic events in relation to cognition among Black and White older adults in the Health and Retirement Study (HRS). PARTICIPANTS Participants (N = 13,952) aged 55+ had complete lifetime trauma and cognitive testing data at the 2006/08, 2010/12, and/or 2014/16 waves. MEASURES Trauma indices comprised childhood and adulthood event counts. Outcomes included baseline performance and trajectories on the Telephone Interview for Cognitive Status. DESIGN Main and nonlinear trauma effects were modeled via linear regression, and overall contributions assessed with omnibus likelihood ratio tests. RESULTS Black participants (N = 2,345) reported marginally lower adulthood trauma exposure than White participants (N = 11,607) with no other exposure differentials observed. In White participants only, greater childhood trauma exposure predicted worse baseline cognition but slower change over time. Across race, adulthood trauma robustly associated with baseline cognition. Relationships were frequently nonlinear: low but nonzero trauma predicted highest cognitive scores, with much poorer cognition observed as trauma exposure increased. Relationships between adulthood trauma and trajectory were limited to the White sample. CONCLUSION Traumatic experiences, particularly in adulthood, may impact late-life cognitive health if not addressed. Findings highlight foci for clinical researchers and providers: adverse life events as a source of cognitive risk, and identification of community-specific resources that buffer behavioral, physical, and mental health sequelae of previous and incident trauma.
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Affiliation(s)
- Megan Zuelsdorff
- School of Nursing (MZ), University of Wisconsin-Madison, Madison, WI; Alzheimer's Disease Research Center (MZ), University of Wisconsin-Madison, Madison, WI.
| | - Amanda Sonnega
- Institute for Social Research (AS), University of Michigan, Ann Arbor, MI
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center (LLB), Rush University Medical Center, Chicago, IL
| | - DeAnnah R Byrd
- Edson College of Nursing and Health Innovation (DARB), Arizona State University, Phoenix, AZ; Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation (DARB), Arizona State University, Phoenix, AZ
| | | | - Robynn Cox
- School of Public Policy (RC), University of California, Riverside, CA
| | - Derek Norton
- Department of Biostatistics and Medical Informatics (DN), University of Wisconsin, Madison, WI
| | - Robert W Turner
- School of Medicine & Health Sciences (RWT), The George Washington University, Washington, DC
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Zuelsdorff M, Limaye VS. A Framework for Assessing the Effects of Climate Change on Dementia Risk and Burden. THE GERONTOLOGIST 2024; 64:gnad082. [PMID: 37392416 PMCID: PMC10860581 DOI: 10.1093/geront/gnad082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 07/03/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) represent a public health crisis poised to worsen in a changing climate. Substantial dementia burden is modifiable, attributable to risk rooted in social and environmental conditions. Climate change threatens older populations in numerous ways, but implications for cognitive aging are poorly understood. We illuminate key mechanisms by which climate change will shape incidence and lived experiences of ADRD, and propose a framework for strengthening research, clinical, and policy actions around cognitive health in the context of climate change. Direct impacts and indirect risk pathways operating through built, social, interpersonal, and biomedical systems are highlighted. Air pollution compromises brain health directly and via systemic cardiovascular and respiratory ailments. Flooding and extreme temperatures constrain health behaviors like physical activity and sleep. Medical care resulting from climate-related health shocks imposes economic and emotional tolls on people living with dementia and caregivers. Throughout, inequitable distributions of climate-exacerbated risks and adaptive resources compound existing disparities in ADRD incidence, comorbidities, and care burden. Translational research, including work prioritizing underserved communities, is crucial. A mechanistic framework can guide research questions and methods and identify clinical- and policy-level intervention loci for prevention and mitigation of climate-related impacts on ADRD risk and burden.
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Affiliation(s)
- Megan Zuelsdorff
- School of Nursing, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vijay S Limaye
- Science Office, Natural Resources Defense Council, New York City, New York, USA
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Shipeolu BA, Marie Ahlin K, Fuller-Thomson E. Black-White Racial Disparities in Disabilities Among Older Americans Between 2008 and 2017: Improvements in Cognitive Disabilities but no Progress in Activities of Daily Living or Functional Limitations. Int J Aging Hum Dev 2024; 98:84-102. [PMID: 37643122 PMCID: PMC10699102 DOI: 10.1177/00914150231196092] [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: 08/31/2023]
Abstract
The objectives of this study were to examine the prevalence of race-based disparities in cognitive problems, functional limitations (FLs), and activity of daily living (ADL) limitations between US Black and White older adults in 2008 and 2017, to explore how age, sex, income, and education attenuate these racial disparities, and to determine if Black-White health disparities are narrowing. Secondary analysis of the nationally representative American Community Surveys including 423,066 respondents aged ≥65 (388,602 White, 34,464 Black) in 2008 and 536,984 (488,483 White, 48,501 Black) in 2017. Findings indicate that Black-White racial disparities were apparent for all three outcomes in 2008 and 2017. Approximately half of the racial disparities was attenuated when adjustments were made for education and income. Racial disparities in cognition declined between 2008 and 2017 (p < .001) but persisted unabated in FLs and ADL limitations. Further exploration on the mechanisms of racial disparities is warranted.
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Affiliation(s)
| | - Katherine Marie Ahlin
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Esme Fuller-Thomson
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine & Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Min SH, Topaz M, Lee C, Schnall R. Racial Differences in Older Adult's Mental Health and Cognitive Symptomatology: Identifying Subgroups Using Multiple-Group Latent Class Analysis. J Aging Health 2023:8982643231212547. [PMID: 37907211 PMCID: PMC11139013 DOI: 10.1177/08982643231212547] [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] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Little is known on the potential racial differences in latent subgroup membership based on mental health and cognitive symptomatology among older adults. METHODS This is a secondary data analysis of Wave 2 data from the National Social Life, Health, and Aging Project (N = 1819). Symptoms were depression, anxiety, loneliness, happiness, and cognition. Multiple-group latent class analysis was conducted to identify latent subgroups based on mental health and cognitive symptoms and to compare these differences between race. RESULTS Class 1: "Severe Cognition & Mild-Moderate Mood Impaired," Class 2: "Moderate Cognition & Mood Impaired," and Class 3: "Mild Cognition Impaired & Healthy Mood" were identified. Black older adults were more likely to be in Class 1 while White older adults were more likely to be in Class 2 and Class 3. DISCUSSION Clinicians need to provide culturally-sensitive care when assessing and treating symptoms across different racial groups.
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Affiliation(s)
- Se Hee Min
- School of Nursing, Columbia University, New York, NY, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, NY, USA
| | - Chiyoung Lee
- Bothell School of Nursing & Health Studies, University of Washington, Bothell, WA, USA
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Bhattarai A, Dimitropoulos G, Bulloch AGM, Tough SC, Patten SB. Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study. BMC Public Health 2023; 23:2036. [PMID: 37853382 PMCID: PMC10585893 DOI: 10.1186/s12889-023-16935-7] [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: 06/21/2022] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors. METHODS The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994-2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035). RESULTS During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM. CONCLUSION The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.
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Affiliation(s)
- Asmita Bhattarai
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Faculty of Social Work, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
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12
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Garcia M, Paulus A, Vázquez-Reyes S, Klementieva O, Gouras G, Bachiller S, Deierborg T. Maternal separation differentially modulates early pathology by sex in 5xFAD Alzheimer's disease-transgenic mice. Brain Behav Immun Health 2023; 32:100663. [PMID: 37503358 PMCID: PMC10369403 DOI: 10.1016/j.bbih.2023.100663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disease. Most cases of AD are considered idiopathic and likely due to a combination of genetic, environmental, and lifestyle-related risk factors. Despite occurring decades before the typical age of an AD diagnosis, early-life stress (ELS) has been suggested to have long-lasting effects that may contribute to AD risk and pathogenesis. Still, the mechanisms that underlie the role of ELS on AD risk remain largely unknown. Here, we used 5xFAD transgenic mice to study relatively short-term alterations related to ELS in an AD-like susceptible mouse model at 6 weeks of age. To model ELS, we separated pups from their dams for 3 h per day from postnatal day 2-14. Around 6 weeks of age, we found that maternally separated (MS) 5xFAD mice, particularly female mice, displayed increased amyloid-β-immunoreactivity in the anterior cingulate cortex (ACC) and basolateral amygdala (BLA). In anterior cingulate cortex, we also noted significantly increased intraneuronal amyloid-β-immunoreactivity associated with MS but only in female mice. Moreover, IBA1-positive DAPI density was significantly increased in relation to MS in ACC and BLA, and microglia in BLA of MS mice had significantly different morphology compared to microglia in non-MS 5xFAD mice. Cytokine analysis showed that male MS mice, specifically, had increased levels of neuroinflammatory markers CXCL1 and IL-10 in hippocampal extracts compared to non-MS counterparts. Additionally, hippocampal extracts from both male and female MS 5xFAD mice had decreased levels of synapse- and activity-related markers Bdnf, 5htr6, Cox2, and Syp in hippocampus. Lastly, we performed behavioral tests to evaluate anxiety- and depressive-like behavior and working memory but could not detect any significant differences between groups. Overall, we detected several sex-specific molecular and cellular alterations in 6-week-old adolescent 5xFAD mice associated with MS that may help explain the connection between ELS and AD risk.
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Affiliation(s)
- M.G. Garcia
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
- Experimental Dementia Research Unit, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
| | - A. Paulus
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
- Medical Microspectroscopy, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
| | - S. Vázquez-Reyes
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
| | - O. Klementieva
- Medical Microspectroscopy, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
| | - G.K. Gouras
- Experimental Dementia Research Unit, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
| | - S. Bachiller
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
- Institute of Biomedicine of Seville, IBiS/Virgen del Rocío University Hospital/CSIC/University of Seville/Seville, Spain
- Department of Medical Biochemistry, Molecular Biology and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - T. Deierborg
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, 22184 Lund, Sweden
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13
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Franco-Rocha OY, Lewis KA, Longoria KD, De La Torre Schutz A, Wright ML, Kesler SR. Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review. J Cancer Res Clin Oncol 2023; 149:12561-12587. [PMID: 37432455 DOI: 10.1007/s00432-023-05088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. METHODS We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. RESULTS Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. CONCLUSIONS Our findings indicate that racial and ethnic minoritized individuals may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA.
| | - Kimberly A Lewis
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kayla D Longoria
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Alexa De La Torre Schutz
- Brain Health Neuroscience Lab, School of Nursing, The University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
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14
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Rotblatt LJ, Aiken-Morgan AT, Marsiske M, Horgas AL, Thomas KR. Do Associations Between Vascular Risk and Mild Cognitive Impairment Vary by Race? J Aging Health 2023; 35:74S-83S. [PMID: 33497299 PMCID: PMC8310897 DOI: 10.1177/0898264320984357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: Given prevalence differences of mild cognitive impairment (MCI) among Black and white older adults, this study aimed to examine whether overall vascular risk factor (VRF) burden and individual VRF associations with amnestic (aMCI) and nonamnestic (naMCI) MCI status varied by Black/white race. Methods: Participants included 2755 older adults without dementia from the ACTIVE study. Comprehensive neuropsychological criteria were used to classify cognitively normal, aMCI, and naMCI. VRFs were primarily defined using subjective report and medication data. Multinomial logistic regression was run predicting MCI subtype. Results: Greater overall VRF burden, high cholesterol, and obesity evinced greater odds of naMCI in Black participants than whites. Across participants, diabetes and hypertension were associated with increased odds of aMCI and naMCI, respectively. Discussion: Results may reflect known systemic inequities on dimensions of social determinants of health for Black older adults. Continued efforts toward examining underlying mechanisms contributing to these findings are critical.
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Affiliation(s)
- Lindsay J. Rotblatt
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Ann L. Horgas
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL
| | - Kelsey R. Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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15
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Hill-Jarrett TG. The Black radical imagination: a space of hope and possible futures. Front Neurol 2023; 14:1241922. [PMID: 37808484 PMCID: PMC10557459 DOI: 10.3389/fneur.2023.1241922] [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: 06/17/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
The radical imagination entails stepping outside the confines of the now and into the expansiveness of what could be. It has been described as the ability to dream of possible futures and bring these possibilities back to the present to drive social transformation. This perspective paper seeks to provide an overview of the radical imagination and its intersections with Afrofuturism, a framework and artistic epistemology that expresses the Black cultural experience through a space of hope where Blackness is integral. In this paper, I propose three processes that comprise the radical imagination: (1) imagining alternative Black futures, (2) radical hope, and (3) collective courage. I consider the neural networks that underlie each process and consider how the Black radical imagination is a portal through which aging Black adults experience hope and envision futures that drive social change. I conclude with considerations of what brain health and healing justice looks like for aging Black Americans- specifically, how invocation of the Black radical imagination may have positive brain health effects for a demographic group at increased risk for Alzheimer's disease and related dementias.
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Affiliation(s)
- Tanisha G. Hill-Jarrett
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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16
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Lim AC, Barnes LL, Weissberger GH, Lamar M, Nguyen AL, Fenton L, Herrera J, Han SD. Quantification of race/ethnicity representation in Alzheimer's disease neuroimaging research in the USA: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:101. [PMID: 37491471 PMCID: PMC10368705 DOI: 10.1038/s43856-023-00333-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Racial and ethnic minoritized groups are disproportionately at risk for Alzheimer's Disease (AD), but are not sufficiently recruited in AD neuroimaging research in the United States. This is important as sample composition impacts generalizability of findings, biomarker cutoffs, and treatment effects. No studies have quantified the breadth of race/ethnicity representation in the AD literature. METHODS This review identified median race/ethnicity composition of AD neuroimaging US-based research samples available as free full-text articles on PubMed. Two types of published studies were analyzed: studies that directly report race/ethnicity data (i.e., direct studies), and studies that do not report race/ethnicity but used data from a cohort study/database that does report this information (i.e., indirect studies). RESULTS Direct studies (n = 719) have median representation of 88.9% white or 87.4% Non-Hispanic white, 7.3% Black/African American, and 3.4% Hispanic/Latino ethnicity, with 0% Asian American, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native, Multiracial, and Other Race participants. Cohort studies/databases (n = 44) from which indirect studies (n = 1745) derived are more diverse, with median representation of 84.2% white, 83.7% Non-Hispanic white, 11.6% Black/African American, 4.7% Hispanic/Latino, and 1.75% Asian American participants. Notably, 94% of indirect studies derive from just 10 cohort studies/databases. Comparisons of two time periods using a median split for publication year, 1994-2017 and 2018-2022, indicate that sample diversity has improved recently, particularly for Black/African American participants (3.39% from 1994-2017 and 8.29% from 2018-2022). CONCLUSIONS There is still underrepresentation of all minoritized groups relative to Census data, especially for Hispanic/Latino and Asian American individuals. The AD neuroimaging literature will benefit from increased representative recruitment of ethnic/racial minorities. More transparent reporting of race/ethnicity data is needed.
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Affiliation(s)
- Aaron C Lim
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gali H Weissberger
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Raman Gat, Israel
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Jennifer Herrera
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA.
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA.
- USC School of Gerontology, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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17
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Bancks MP, Byrd G, Caban-Holt A, Fitzpatrick AL, Forrester SN, Hayden KM, Heckbert SR, Kershaw KN, Rapp SR, Sachs BC, Hughes TM. Self-reported experiences of discrimination and incident dementia. Alzheimers Dement 2023; 19:3119-3128. [PMID: 36724324 PMCID: PMC10390651 DOI: 10.1002/alz.12947] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/09/2022] [Accepted: 12/20/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Discrimination negatively impacts health and may contribute to racial/ethnic disparities in dementia risk. METHODS Experiences of lifetime and everyday discrimination were assessed among 6509 Multi-Ethnic Study of Atherosclerosis (MESA) participants. We assessed the association of discrimination with incidence of dementia including adjustment for important risk factors, cohort attrition, and we assessed for effect modification by race/ethnicity. RESULTS Prevalence of any lifetime discrimination in MESA was 42%, highest among Black adults (72%). Over a median 15.7 years of follow-up, there were 466 incident cases of dementia. Lifetime discrimination, but not everyday discrimination, was associated with incident dementia (Wald p = 0.03). Individuals reporting lifetime discrimination in ≥2 domains (compared to none) had greater risk for dementia (hazard ratio: 1.40; 95%: 1.08, 1.82) after adjustment for sociodemographic, clinical, and behavioral risk factors. Associations did not differ by race/ethnicity. CONCLUSIONS These findings demonstrate an association of greater experiences of lifetime discrimination with incident dementia.
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Affiliation(s)
| | - Goldie Byrd
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | - Stephen R. Rapp
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bonnie C. Sachs
- Wake Forest University School of Medicine, Winston-Salem, NC
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18
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Savold J, Cole M, Thorpe RJ. Barriers and solutions to Alzheimer's disease clinical trial participation for Black Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12402. [PMID: 37408664 PMCID: PMC10318422 DOI: 10.1002/trc2.12402] [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: 02/09/2023] [Revised: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
Introduction Black Americans are disproportionately burdened by Alzheimer's disease (AD) relative to other racial groups in the United States and continue to be underrepresented in AD clinical trials. This review explores the primary barriers for participation in clinical trials among Black Americans and provides literature-based recommendations to improve the inclusion of Black Americans in AD clinical trials. Methods We searched electronic databases and gray literature for articles published in the United States through January 1, 2023, ultimately identifying 26 key articles for inclusion. Results Barriers to participation in clinical trials for Black Americans are rooted in social determinants of health, including access to quality education and information, access to health care, economic stability, built environment, and community context. Best practices to improve the inclusion of Black Americans in clinical trials require pharmaceutical companies to adopt a multifaceted approach, investing in innovative strategies for site selection, development of local partnerships, outreach, and education. Discussion While multisectoral action must occur to effectively address the disproportionate burden of AD on Black Americans, the pharmaceutical industry has an important part to play in this space due to their central role in product development and clinical trials.
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Affiliation(s)
- Jordan Savold
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michele Cole
- Global Market Access, Neuroscience Therapeutic AreaJohnson & JohnsonRaritanNew JerseyUSA
| | - Roland J. Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging ResearchBaltimoreMarylandUSA
- Johns Hopkins Center for Health Disparities SolutionsBaltimoreMarylandUSA
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19
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Simons R, Ong M, Beach S, Lei MK, Philibert R, Mielke M. Direct and Indirect Effects of Socioeconomic Status and Discrimination on Subjective Cognitive Decline: A Longitudinal Study of African American Women. J Gerontol B Psychol Sci Soc Sci 2023; 78:799-808. [PMID: 36810805 PMCID: PMC10195880 DOI: 10.1093/geronb/gbad029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES The present study builds on recent findings suggesting that the stress of institutional and interpersonal racism may contribute to African Americans' elevated risk for dementia. We investigated the extent to which 2 consequences of racism-low socioeconomic status (SES) and discrimination-predict self-reported cognitive decline (SCD) 19 years later. Further, we examined potential mediating pathways that might link SES and discrimination to cognitive decline. Potential mediators included depression, accelerated biological aging, and onset of chronic illnesses. METHODS Hypotheses were tested using a sample of 293 African American women. SCD was assessed using the Everyday Cognition Scale. Structural equation modeling was used to assess the effects of SES and racial discrimination, both measured in 2002, on SCD reported in 2021. Turning to the mediators, midlife depression was assessed in 2002, accelerated aging in 2019, and chronic illness in 2019. Age and prodrome depression were included as covariates. RESULTS There were direct effects of SES and discrimination on SCD. In addition, these 2 stressors showed a significant indirect effect on SCD through depression. Finally, there was evidence for a more complex pathway where SES and discrimination accelerate biological aging, with accelerated aging, in turn leading to chronic illness, which then predicted SCD. DISCUSSION Results of the present study add to a growing literature indicating that living in a racialized society is a central factor in explaining the high risk for dementia among Black Americans. Future research should continue to emphasize the various ways that exposure to racism over the life course effects cognition.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia,
Athens, Georgia, USA
| | - Mei Ling Ong
- Center for Family Research, University of Georgia,
Athens, Georgia, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia,
Athens, Georgia, USA
| | - Man-Kit Lei
- Department of Sociology, University of Georgia,
Athens, Georgia, USA
| | - Robert Philibert
- Department of Psychiatry, University of Iowa School of
Medicine, Iowa City, Iowa, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University, School
of Medicine, Winston-Salem, North Carolina,
USA
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20
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Saez-Sanz N, Peralta-Ramirez I, Gonzalez-Perez R, Vazquez-Justo E, Caracuel A. Resilience, Stress, and Cortisol Predict Cognitive Performance in Older Adults. Healthcare (Basel) 2023; 11:healthcare11081072. [PMID: 37107906 PMCID: PMC10137485 DOI: 10.3390/healthcare11081072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE to determine the relationship between stress, resilience, and cognitive performance in older people without dementia. METHOD multiple linear regressions were performed using measures of cognitive performance as dependent variables, and measures of stress and resilience as predictors in a sample of 63 Spanish elderly people. RESULTS participants reported low levels of stress during their lifetime. In addition to socio-demographic variables, greater stress was related to better delayed recall and worse letter-number sequencing and block design. Higher capillary cortisol was associated with lower flexibility on the Stroop task. Regarding protective factors, we found that greater psychological resilience was related to higher scores on the Addenbrooke's Cognitive Examination-III, letter-number sequencing, and verbal fluency. CONCLUSION in older people with low stress, apart from age, gender, and education, psychological resilience is a significant predictor of global cognitive status, working memory, and fluency. Likewise, stress is related to verbal memory functioning, working memory, and visuoconstructive abilities. Capillary cortisol level predicts cognitive flexibility. These findings may help to identify risk and protective factors for cognitive decline in older people. Training-based programs to reduce stress and increase psychological resilience may play an important role in preventing cognitive decline.
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Affiliation(s)
- Noelia Saez-Sanz
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
- Department of Psychology and Anthropology, University of Extremadura, 06006 Badajoz, Spain
| | - Isabel Peralta-Ramirez
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
- Department of Personality, Evaluation, and Psychological Treatment, University of Granada, 18071 Granada, Spain
| | - Raquel Gonzalez-Perez
- Department of Pharmacology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, 18012 Granada, Spain
| | - Enrique Vazquez-Justo
- Center for Research, Development and Innovation (CIDI-IEES), European Institute for Higher Studies, 4824-909 Fafe, Portugal
| | - Alfonso Caracuel
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
- Department of Developmental and Educational Psychology, University of Granada, 18071 Granada, Spain
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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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Ratcliffe LN, McDonald T, Robinson B, Sass JR, Loring DW, Hewitt KC. Classification statistics of the Montreal Cognitive Assessment (MoCA): Are we interpreting the MoCA correctly? Clin Neuropsychol 2023; 37:562-576. [PMID: 35699222 PMCID: PMC10351673 DOI: 10.1080/13854046.2022.2086487] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) is a common cognitive screener for detecting mild cognitive impairment (MCI). However, previously suggested cutoff scores of 26/30 and above is often criticized and lacks racial diversity. The purpose of this study is to investigate the potential influence of race on MoCA classification cutoff score accuracy. METHOD Data were obtained from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set and yielded 4,758 total participants. Participants were predominately White (82.8%) and female (61.7%) with a mean age of 69.3 years (SD = 10.3) and education level of 16.3 years (SD = 2.6). Based on NACC's classification, participants were either cognitively normal (n = 3,650) or MCI (n = 1,108). RESULTS Sensitivity and specificity analyses revealed that when using the cutoff score of ≤26/30, the MoCA correctly classified 73.2% of White cognitively normal participants and 83.1% of White MCI participants. In contrast, this criterion correctly classified 40.5% of Black cognitively normal participants and 90.8% of Black MCI participants. Our sample was highly educated; therefore, we did not observe significant differences in scores when accounting for education across race. Classification statistics are presented. CONCLUSIONS Black participants were misclassified at a higher rate than White participants when applying the ≤26/30 cutoff score. We suggest cutoff scores of ≤25/30 be applied to White persons and ≤22/30 for Black persons. These findings highlight the need for racially stratified population-based norms given the high misclassification of Black participants without such adjustment.
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Affiliation(s)
- Lauren N. Ratcliffe
- Department of Clinical Psychology, Mercer University College of Health Professions, Atlanta, GA, USA
| | - Taylor McDonald
- Department of Clinical Psychology, Mercer University College of Health Professions, Atlanta, GA, USA
| | - Brittany Robinson
- Department of Clinical Psychology, Mercer University College of Health Professions, Atlanta, GA, USA
| | - John R. Sass
- Cognitive Rehabilitation of Georgia, Atlanta, GA, USA
- Restore Health Group, Atlanta, GA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelsey C. Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Cai J, Bidulescu A. The association between food insecurity and cognitive impairment among the US adults: The mediation role of anxiety or depression. J Affect Disord 2023; 325:73-82. [PMID: 36603601 DOI: 10.1016/j.jad.2022.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Using a nationally representative sample, this study aimed to examine (1) socio-demographic and health-related disparities in cognitive impairment, (2) the association between food insecurity and cognitive impairment, and (3) the mediation role of anxiety or depression in the pathway between food insecurity and cognitive impairment. METHODS Cross-sectional data of 28,508 adults from the 2020 National Health Interview Survey were analyzed. Multivariable logistic regression models were used to estimate associations with cognitive impairment. Mediation analyses were conducted using the four-way decomposition method under a counterfactual framework. RESULTS Disparities in cognitive impairment were observed across socio-demographic and health-related characteristics (all p < 0.0001). Food insecurity was significantly associated with cognitive impairment in the overall population and the magnitude of the association was greater for the young or middle-aged, females and non-Hispanic Blacks than the general population (AOR ranged from 1.19 to 2.54, all p < 0.01). With anxiety as a mediator, 28.66 % of the total effect of food insecurity on cognitive impairment was attributable to mediation only, and 22.39 % was attributable to interaction (between food insecurity and anxiety) and mediation. With depression as a mediator, 22.33 % of the total effect was attributable to mediation only, and 16.00 % was attributable to interaction (between food insecurity and depression) and mediation. LIMITATIONS The cross-sectional design prevents inference of causality. CONCLUSIONS Ensuring available and adequate food resources is important to prevent adverse cognitive outcomes. Clinical interventions or treatments for anxiety or depression may help improve cognitive function.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America
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24
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Bayram E, Holden SK, Fullard M, Armstrong MJ. Race and Ethnicity in Lewy Body Dementia: A Narrative Review. J Alzheimers Dis 2023; 94:861-878. [PMID: 37355902 PMCID: PMC10448838 DOI: 10.3233/jad-230207] [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] [Indexed: 06/26/2023]
Abstract
Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson's disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer's disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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25
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Kohler IV, Kämpfen F, Bandawe C, Kohler HP. Cognition and Cognitive Changes in a Low-Income Sub-Saharan African Aging Population. J Alzheimers Dis 2023; 95:195-212. [PMID: 37522209 PMCID: PMC10588811 DOI: 10.3233/jad-230271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Cognition and its age-related changes remain vastly understudied in low-income countries (LICs), despite evidence suggesting that cognitive decline among aging low-income populations is a rapidly increasing disease burden often occurring at younger ages as compared to high-income countries (HICs). OBJECTIVE We examine patterns of cognition among men and women, 45 + years old, living in rural Malawi. We analyze how key socioeconomic characteristics predict levels of cognition and its changes as individuals get older. METHODS Utilizing the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) collected during 2012-2017, we estimate standard regression models to analyze predictors of the age- and sex-specific levels and longitudinal changes in cognition. Cognition is assessed with a screening instrument that is adapted to this low-literacy context and measures different domains such as language, attention, or executive functioning. RESULTS Women have lower levels of cognition than men, a pattern in stark contrast to findings in HICs. Schooling and socioeconomic status increase the probability of having consistently high performance during the cognitive assessment. Cognitive decline accelerates with age and is detectable already at mid-adult ages (45-55 years). Despite lower levels of cognitive function observed among women, the pace of decline with age is similar for both genders. CONCLUSION Women are particularly affected by poor cognition in this context. The study emphasizes the importance of prioritizing cognitive health and research on cognition among older individuals in sub-Saharan Africa LICs, to which relatively little health care resources continue to be allocated.
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Affiliation(s)
- Iliana V Kohler
- Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Chiwoza Bandawe
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
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26
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Avila-Rieger J, Turney IC, Vonk JMJ, Esie P, Seblova D, Weir VR, Belsky DW, Manly JJ. Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women. Neurology 2022; 99:e2114-e2124. [PMID: 36038275 PMCID: PMC9651454 DOI: 10.1212/wnl.0000000000201032] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure to socioeconomic disadvantage is associated with early-onset cognitive aging. Biological aging, the progressive loss of system integrity that occurs as we age, is proposed as a modifiable process mediating this health inequality. We examined whether socioeconomic disparities in cognitive aging in mid-to late-life adults is explained by accelerated biological aging similarly across race, ethnicity, and sex/gender. METHODS Data were from a prospective cohort study of the US Health and Retirement Study DNA methylation substudy. Socioeconomic status (SES) was measured from years of education and household wealth at baseline. The extent and pace of biological aging were quantified using 3 DNA methylation measures: PhenoAge, GrimAge, and DunedinPoAm. Cognitive aging was measured from repeated longitudinal assessments of immediate and delayed word recall. Latent growth curve modeling estimated participants' level of memory performance and rate of decline over 2-11 follow-up assessments spanning 2-20 years. Multiple-group models were estimated to assess whether the relationship between SES and memory trajectories was mediated by biological aging across racial-ethnic by sex/gender subgroups. RESULTS Data from a total of 3,997 adults aged 50-100 years were analyzed. Participants with lower SES had a lower memory performance, had a faster decline, and exhibited accelerated biological aging (SES effect size associations [β] ranged from 0.08 to 0.41). Accelerated biological aging was associated with decreased memory performance and faster memory decline (effect size range 0.03-0.23). SES-biological aging associations were the strongest for White men and women and weakest for Latinx women. The relationship between biological aging measures and memory was weaker for Black participants compared with that for White and Latinx people. In mediation analysis, biological aging accounted for 4%-27% of the SES-memory gradient in White participants. There was little evidence of mediation in Black or Latinx participants. DISCUSSION Among a national sample of mid-to late-life adults, DNA methylation measures of biological aging were variably associated with memory trajectories and SES across White, Black, and Latinx mid-to late-life adults. These results challenge the assumption that DNA methylation biomarkers of aging that were developed in primarily White people can equivalently quantify aging processes affecting cognition in Black and Latinx mid-to late-life adults.
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Affiliation(s)
- Justina Avila-Rieger
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Indira C Turney
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jet M J Vonk
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Precious Esie
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Dominika Seblova
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Vanessa R Weir
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Daniel W Belsky
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jennifer J Manly
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY.
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27
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Avila-Rieger J, Turney IC, Vonk JMJ, Esie P, Seblova D, Weir VR, Belsky DW, Manly JJ. Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women. Neurology 2022; 99:e2114-e2124. [PMID: 36038275 PMCID: PMC9651454 DOI: 10.1212/wnl.0000000000201032 10.1212/wnl.0000000000201032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/13/2022] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure to socioeconomic disadvantage is associated with early-onset cognitive aging. Biological aging, the progressive loss of system integrity that occurs as we age, is proposed as a modifiable process mediating this health inequality. We examined whether socioeconomic disparities in cognitive aging in mid-to late-life adults is explained by accelerated biological aging similarly across race, ethnicity, and sex/gender. METHODS Data were from a prospective cohort study of the US Health and Retirement Study DNA methylation substudy. Socioeconomic status (SES) was measured from years of education and household wealth at baseline. The extent and pace of biological aging were quantified using 3 DNA methylation measures: PhenoAge, GrimAge, and DunedinPoAm. Cognitive aging was measured from repeated longitudinal assessments of immediate and delayed word recall. Latent growth curve modeling estimated participants' level of memory performance and rate of decline over 2-11 follow-up assessments spanning 2-20 years. Multiple-group models were estimated to assess whether the relationship between SES and memory trajectories was mediated by biological aging across racial-ethnic by sex/gender subgroups. RESULTS Data from a total of 3,997 adults aged 50-100 years were analyzed. Participants with lower SES had a lower memory performance, had a faster decline, and exhibited accelerated biological aging (SES effect size associations [β] ranged from 0.08 to 0.41). Accelerated biological aging was associated with decreased memory performance and faster memory decline (effect size range 0.03-0.23). SES-biological aging associations were the strongest for White men and women and weakest for Latinx women. The relationship between biological aging measures and memory was weaker for Black participants compared with that for White and Latinx people. In mediation analysis, biological aging accounted for 4%-27% of the SES-memory gradient in White participants. There was little evidence of mediation in Black or Latinx participants. DISCUSSION Among a national sample of mid-to late-life adults, DNA methylation measures of biological aging were variably associated with memory trajectories and SES across White, Black, and Latinx mid-to late-life adults. These results challenge the assumption that DNA methylation biomarkers of aging that were developed in primarily White people can equivalently quantify aging processes affecting cognition in Black and Latinx mid-to late-life adults.
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Affiliation(s)
- Justina Avila-Rieger
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Indira C Turney
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jet M J Vonk
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Precious Esie
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Dominika Seblova
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Vanessa R Weir
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Daniel W Belsky
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jennifer J Manly
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY.
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Gleason CE, Zuelsdorff M, Gooding DC, Kind AJH, Johnson AL, James TT, Lambrou NH, Wyman MF, Ketchum FB, Gee A, Johnson SC, Bendlin BB, Zetterberg H. Alzheimer's disease biomarkers in Black and non-Hispanic White cohorts: A contextualized review of the evidence. Alzheimers Dement 2022; 18:1545-1564. [PMID: 34870885 PMCID: PMC9543531 DOI: 10.1002/alz.12511] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023]
Abstract
Black Americans are disproportionately affected by dementia. To expand our understanding of mechanisms of this disparity, we look to Alzheimer's disease (AD) biomarkers. In this review, we summarize current data, comparing the few studies presenting these findings. Further, we contextualize the data using two influential frameworks: the National Institute on Aging-Alzheimer's Association (NIA-AA) Research Framework and NIA's Health Disparities Research Framework. The NIA-AA Research Framework provides a biological definition of AD that can be measured in vivo. However, current cut-points for determining pathological versus non-pathological status were developed using predominantly White cohorts-a serious limitation. The NIA's Health Disparities Research Framework is used to contextualize findings from studies identifying racial differences in biomarker levels, because studying biomakers in isolation cannot explain or reduce inequities. We offer recommendations to expand study beyond initial reports of racial differences. Specifically, life course experiences associated with racialization and commonly used study enrollment practices may better account for observations than exclusively biological explanations.
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Affiliation(s)
- Carey E. Gleason
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical Center (11G)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- University of Wisconsin School of NursingMadisonWisconsinUSA
| | - Diane C. Gooding
- Department of PsychologyUniversity of Wisconsin, MadisonMadisonWisconsinUSA
- Department of PsychiatryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Amy J. H. Kind
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical Center (11G)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
- Center for Health Disparities ResearchDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Adrienne L. Johnson
- Center for Tobacco Research and InterventionUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Taryn T. James
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Nickolas H. Lambrou
- Geriatric ResearchEducation and Clinical Center (11G)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Mary F. Wyman
- Geriatric ResearchEducation and Clinical Center (11G)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
- Department of PsychologyUniversity of Wisconsin, MadisonMadisonWisconsinUSA
| | - Fred B. Ketchum
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alexander Gee
- Nehemiah Center for Urban Leadership DevelopmentMadisonWisconsinUSA
| | - Sterling C. Johnson
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical Center (11G)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Barbara B. Bendlin
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of Neurology, Queen SquareLondonUK
- UK Dementia Research Institute at UCLLondonUK
- Hong Kong Center for NeurodegenerationHong KongChina
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Wyman MF, Van Hulle CA, Umucu E, Livingston S, Lambrou NH, Carter FP, Johnson SC, Asthana S, Gleason CE, Zuelsdorff M. Psychological well-being and cognitive aging in Black, Native American, and White Alzheimer's Disease Research Center participants. Front Hum Neurosci 2022; 16:924845. [PMID: 35967004 PMCID: PMC9372578 DOI: 10.3389/fnhum.2022.924845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/05/2022] [Indexed: 01/25/2023] Open
Abstract
Psychological well-being is associated with cognition in later life but has not been examined across diverse populations-including minoritized communities at disproportionately high risk of dementia. Further, most previous work has not been able to examine links between specific facets of psychological well-being and performance within distinct cognitive domains that can capture subclinical impairment. Using a well-characterized sample followed through enrollment in an NIH-funded Alzheimer's Disease Center, we sought to test these associations within three racial groups at baseline. Participants were N = 529 cognitively unimpaired Black, American Indian/Alaska Native (AI/AN), and white middle-aged and older adults (mean age = 63.6, SD = 8.1, range = 45-88 years) enrolled in the Wisconsin Alzheimer's Disease Research Center's Clinical Core. Predictors included validated NIH Toolbox Emotion Battery scales assessing positive affect, general life satisfaction, and meaning and purpose. Outcomes included performance on widely used tests of executive functioning and episodic memory. We conducted race-stratified regression models to assess within-group relationships. Black and AI/AN participants reported lower life satisfaction than white participants. Racial disparities were not observed for positive affect or meaning and purpose scores. Across groups, life satisfaction predicted better executive functioning. Similar associations were observed for positive affect in Black and AI/AN samples but not among whites. In general, well-being measures were not related to performance on tests of episodic memory. Our results highlight well-being as a potentially important determinant of late-life cognitive health, particularly executive functioning, that is modifiable if older adults are connected with appropriate resources and supports. Further, psychological well-being may represent a potent target for brain health interventions tailored for Black and Native communities.
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Affiliation(s)
- Mary F. Wyman
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Carol A. Van Hulle
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Emre Umucu
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, Lansing, MI, United States
| | - Sydnee Livingston
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
| | - Nickolas H. Lambrou
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
| | - Fabu P. Carter
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Sterling C. Johnson
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Sanjay Asthana
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Carey E. Gleason
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Megan Zuelsdorff
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
- School of Nursing, University of Wisconsin, Madison, WI, United States
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Rosas C, Oliveira HC, Neri AL, Ceolim MF. Stressful events, depressive symptoms, and frailty associated to older adults’ survival and mortality. Geriatr Nurs 2022; 46:62-68. [DOI: 10.1016/j.gerinurse.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
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Boots EA, Feinstein DL, Leurgans S, Aiken-Morgan AT, Fleischman DA, Lamar M, Barnes LL. Acute versus chronic inflammatory markers and cognition in older black adults: Results from the Minority Aging Research Study. Brain Behav Immun 2022; 103:163-170. [PMID: 35439553 PMCID: PMC9704497 DOI: 10.1016/j.bbi.2022.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022] Open
Abstract
Peripheral inflammation is elevated in older Black adults, an elevation which prior work has suggested may be due to chronic stress associated with systemic racism and related adverse cardiovascular health conditions. Inflammation is also involved in the pathogenic processes of dementia; however, limited (and mixed) results exist concerning inflammation and cognitive decline in Black adults. We characterized patterns of inflammation and their role in cognitive decline in 280 older Black adults (age = 72.99 ± 6.00 years; 69.6% female) from the Minority Aging Research Study (MARS) who were without dementia at baseline and followed between 2 and 15 years (mean = 9 years). Participants completed a blood draw at baseline and annual cognitive evaluations. Serum was assayed for 9 peripheral inflammatory markers; 19 neuropsychological test scores were used to create indices of global cognition and five cognitive domains. Principal component analysis with varimax rotation characterized patterns of inflammation with factor loadings > 0.6 per component contributing to two composite scores representing acute/upstream and chronic/downstream inflammation. These composites were used as separate predictors in linear mixed regression models to determine associations with level and change in cognition adjusting for relevant covariates. Higher baseline upstream/acute inflammation associated with lower baseline semantic memory (p = .040) and perceptual speed (p = .046); it was not related to cognitive decline. By contrast, higher baseline downstream/chronic inflammation associated with faster declines in global cognition (p = .010), episodic (p = .027) and working memory (p = .006); it was not related to baseline cognition. For older Black adults, chronic, but not acute, inflammation may be a risk factor for changes in cognition.
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Affiliation(s)
- Elizabeth A Boots
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60607, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Douglas L Feinstein
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA; Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Sue Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Adrienne T Aiken-Morgan
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC 27516, USA
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
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Saiyasit N, Butlig EAR, Chaney SD, Traylor MK, Hawley NA, Randall RB, Bobinger HV, Frizell CA, Trimm F, Crook ED, Lin M, Hill BD, Keller JL, Nelson AR. Neurovascular Dysfunction in Diverse Communities With Health Disparities-Contributions to Dementia and Alzheimer's Disease. Front Neurosci 2022; 16:915405. [PMID: 35844216 PMCID: PMC9279126 DOI: 10.3389/fnins.2022.915405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease and related dementias (ADRD) are an expanding worldwide crisis. In the absence of scientific breakthroughs, the global prevalence of ADRD will continue to increase as more people are living longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and have often been neglected by the scientific research community. There is mounting evidence that vascular insults in the brain can initiate a series of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our local diverse community. Toward this goal, the primary objective of this review was to investigate and better understand health disparities in Alabama and the contributions of the social determinants of health to those disparities, particularly in the context of vascular dysfunction in ADRD. Here, we explain the neurovascular dysfunction associated with Alzheimer's disease (AD) as well as the intrinsic and extrinsic risk factors contributing to dysfunction of the neurovascular unit (NVU). Next, we ascertain ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors linked to AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI) and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are adversely affected by social and structural determinants of health leading to health disparities, driven by rurality, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to healthcare and healthy food and other amenities resulting in decreased opportunities for early diagnosis of and pharmaceutical treatments for ADRD. Although this review is focused on the current state of health disparities of ADRD patients in Alabama, future studies must include diversity of race, ethnicity, and region to best be able to treat all individuals affected by ADRD.
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Affiliation(s)
- Napatsorn Saiyasit
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Evan-Angelo R. Butlig
- Department of Neurology, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Intellectual and Developmental Disabilities Research Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha D. Chaney
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Miranda K. Traylor
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Nanako A. Hawley
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Ryleigh B. Randall
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Hanna V. Bobinger
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Carl A. Frizell
- Department of Physician Assistant Studies, University of South Alabama, Mobile, AL, United States
| | - Franklin Trimm
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Errol D. Crook
- Department of Internal Medicine, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Mike Lin
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Joshua L. Keller
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Amy R. Nelson
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
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Stites SD, Midgett S, Mechanic-Hamilton D, Zuelsdorff M, Glover CM, Marquez DX, Balls-Berry JE, Streitz ML, Babulal G, Trani JF, Henderson JN, Barnes LL, Karlawish J, Wolk DA. Establishing a Framework for Gathering Structural and Social Determinants of Health in Alzheimer's Disease Research Centers. THE GERONTOLOGIST 2022; 62:694-703. [PMID: 34919705 PMCID: PMC9154263 DOI: 10.1093/geront/gnab182] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Structural and social determinants of health (SSDoH) are environmental conditions in which individuals are born, live, learn, work, play, worship, and age that affect health, functioning, and quality-of-life outcomes across the life course. Growing evidence suggests that SSDoH can help to explain heterogeneity in outcomes in Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) research and clinical practice. The National Institute on Aging has prioritized collecting SSDoH data to elucidate disease mechanisms and aid discovery of disease-modifying treatments. However, a major nexus of AD/ADRD research, the national network of Alzheimer's Disease Research Centers (ADRCs), collects few SSDoH data. We describe a framework for feasibly gathering and modeling SSDoH data across ADRCs. We lay out key constructs, their measures, and empirical evidence for their importance in elucidating disease and prevention mechanisms. Toward a goal of translation, the framework proposes a modular structure with a core set of measures and options for adjunctive modules. We describe considerations for measuring SSDoH in existing geographically and culturally diverse research cohorts. We also outline a rationale for universal implementation of a set of SSDoH measures and juxtapose the approach with alternatives aimed at collecting SSDoH data.
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Affiliation(s)
- Shana D Stites
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharnita Midgett
- Department of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Megan Zuelsdorff
- Department of Nursing, Wisconsin University, Madison, Wisconsin, USA
| | - Crystal M Glover
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joyce E Balls-Berry
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marissa L Streitz
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ganesh Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Jean-Francois Trani
- Department of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - J Neil Henderson
- Department of Family Medicine and Behavioral Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jason Karlawish
- Department of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dave A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Trajectories of cognitive functioning in later life: Disparities by race/ethnicity, educational attainment, sex, and multimorbidity combinations. SSM Popul Health 2022; 18:101084. [PMID: 35402685 PMCID: PMC8987641 DOI: 10.1016/j.ssmph.2022.101084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/12/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Evaluating multimorbidity combinations, racial/ethnic background, educational attainment, and sex associations with age-related cognitive changes is critical to clarifying the health, sociodemographic, and socioeconomic mechanisms associated with cognitive function in later life. Data from the 2011-2018 National Health and Aging Trends Study for respondents aged 65 years and older (N = 10,548, mean age = 77.5) were analyzed using linear mixed effect models. Racial/ethnic differences (mutually-exclusive groups: non-Latino White, non-Latino Black, and Latino) in cognitive trajectories and significant interactions with sex and education (<high school, high school, some college, and ≥ college degree) were evaluated. Models included sex, education, ever covered by Medicaid, coupled status, waist-height ratio, study cohort, and chronic disease category (no diseases; one disease; advanced cardiovascular multimorbidity; metabolic multimorbidity; advanced cardiovascular-metabolic multimorbidity; and neither advanced cardiovascular nor metabolic multimorbidity). In covariate-adjusted models, Black (b = -1.31, 95% CI: 1.74,-0.89) and Latino (b = -0.83, 95% CI: 1.58,-0.07) respondents had lower cognitive scores at age 65 and steeper declines with age (b = -0.08, 95% CI: -0.15,-0.01; b = -0.20, 95% CI: 0.34,-0.05, respectively) compared with White respondents. Cognitive scores were lower among respondents with advanced cardiovascular (b = -0.28, 95% CI: 0.54,-0.01) and advanced cardiovascular-metabolic (b = -0.56, 95% CI: 0.86,-0.27) multimorbidity compared with respondents with none of the chronic diseases of interest. In interaction models, protective associations by female sex and higher education were not observed among minority racial/ethnic groups. It is important to develop interventions to postpone cognitive decline among older Black and Latino adults.
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Marshall CR, Noyce AJ, Neligan A, Dobson R. Brain health: The hidden casualty of a humanitarian crisis. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100374. [PMID: 35531495 PMCID: PMC9072995 DOI: 10.1016/j.lanepe.2022.100374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Charles R. Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
| | - Alastair J. Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
| | - Aidan Neligan
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Homerton University Hospital, London E9 6SR, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
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Eubank JM, Oberlin DJ, Alto A, Sahyoun NR, Asongwed E, Monroe-Lord L, Harrison EA. Effects of Lifestyle Factors on Cognition in Minority Population of Older Adults: A Review. Front Nutr 2022; 9:841070. [PMID: 35369047 PMCID: PMC8966895 DOI: 10.3389/fnut.2022.841070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
The onset of dementia and Alzheimer's disease (AD) is projected to expand over the next several decades in the United States as the population ages. However, the cognitive health burden is not equally distributed among the population, as Hispanics and African Americans are at higher risk of AD when compared with Non-Hispanic Whites. There is some evidence to indicate that cognitive decline may be associated with lifestyle factors and that interventions in these domains may prevent or delay this decline. These lifestyle factors include social engagement, physical activity, both aerobic and strength training, dietary intake, sleep and stress. This review summarizes, in general, what is known about the relationship between risk factors and cognition and, in particular what is known about this relationship in minority populations. The results show that the relationship between these risk factors and cognitive decline is stronger for some of the factors such as physical activity and dietary intake and weaker for the other factors depending on what is measured and in what populations. It does appear, however, that the studies in minority populations is limited and warrants more targeted research and interventions.
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Affiliation(s)
- Jacob M. Eubank
- Lehman College, City University of New York, New York, NY, United States
- *Correspondence: Jacob M. Eubank ; orcid.org/0000-0003-1806-9308
| | - Douglas J. Oberlin
- Lehman College, City University of New York, New York, NY, United States
| | - Andrew Alto
- Lehman College, City University of New York, New York, NY, United States
| | - Nadine R. Sahyoun
- Department of Nutrition and Food Science, University of Maryland College Park, College Park, MD, United States
| | - Elmira Asongwed
- College of Agriculture, Urban Sustainability and Environmental Sciences, University of the District of Columbia, Washington, DC, United States
| | - Lillie Monroe-Lord
- College of Agriculture, Urban Sustainability and Environmental Sciences, University of the District of Columbia, Washington, DC, United States
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Chen R, Weuve J, Misra S, Cuevas A, Kubzansky LD, Williams DR. Racial Disparities in Cognitive Function Among Middle-Aged and Older Adults: The Roles of Cumulative Stress Exposures Across the Life Course. J Gerontol A Biol Sci Med Sci 2022; 77:357-364. [PMID: 33824971 PMCID: PMC8824673 DOI: 10.1093/gerona/glab099] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Racial disparities in cognitive function are well documented, but factors driving these disparities remain underexplored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black-White disparities in executive function and episodic memory in middle-aged and older adults. METHOD Data were drawn from the 2004-2006 wave of the Midlife Development in the United States Study (MIDUS 2) and the MIDUS Refresher study (N = 5,947; 5,262 White and 685 Black). Cumulative stress exposures were assessed by 10 stressor domains (ie, childhood stress, stressful life events in adulthood, financial stress, work psychological stress, work physical stress, work-family conflicts, neighborhood disorder, relationship stress, perceived inequality, and perceived discrimination). Cognitive function was assessed using the Brief Test of Adult Cognition by Telephone. Marginal structural models were used to quantify the proportion of the effect of race/ethnicity status on cognitive function mediated through cumulative stress exposures. RESULTS After adjusting for age, sex, and sample, on average, Black participants had lower levels of executive function (difference: -0.83 SD units, 95% CI: -0.91, -0.75) and episodic memory (difference: -0.53 SD units, 95% CI: -0.60, -0.45) scores than White participants. Cumulative stress exposures accounted for 8.4% of the disparity in executive function and 13.2% of the disparity in episodic memory. CONCLUSIONS Cumulative stress exposures across the life course explained modest proportions of Black-White disparities in cognitive function in this large cross-sectional study.
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Affiliation(s)
- Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Supriya Misra
- Department of Public Health, San Francisco State University, California, USA
| | - Adolfo Cuevas
- Department of Community Health, School of Arts and Sciences, Tufts University, Boston, Massachusetts, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Bothongo PL, Jitlal M, Parry E, Waters S, Foote IF, Watson CJ, Cuzick J, Giovannoni G, Dobson R, Noyce AJ, Mukadam N, Bestwick JP, Marshall CR. Dementia risk in a diverse population: A single-region nested case-control study in the East End of London. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100321. [PMID: 35558994 PMCID: PMC9088197 DOI: 10.1016/j.lanepe.2022.100321] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Although a relationship between traditional cardiovascular risk factors and stroke has long been recognized, these risk factors likely play a role in other aspects of brain health. Clinical stroke is only the tip of the iceberg of vascular brain injury that includes covert infarcts, white matter hyperintensities, and microbleeds. Furthermore, an individual's risk for not only stroke but poor brain health includes not only these traditional vascular risk factors but also lifestyle and genetic factors. The purpose of this narrative review is to summarize the state of the evidence on traditional and nontraditional vascular risk factors and their contributions to brain health. Additionally, we will review important modifiers that interact with these risk factors to increase, or, in some cases, reduce risk of adverse brain health outcomes, with an emphasis on genes and biomarkers associated with Alzheimer disease. Finally, we will consider the importance of social determinants of health in brain health outcomes.
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Affiliation(s)
- Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD (R.F.G.)
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UTHSA, San Antonio, TX (S.S.).,Department of Neurology, Boston University School of Medicine, Boston, MA (S.S.)
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Gary KM, Hoque M, Yashkin AP, Yashin AI, Akushevich I. Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk? Gerontol Geriatr Med 2022; 8:23337214221142944. [PMID: 36544849 PMCID: PMC9761247 DOI: 10.1177/23337214221142944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer's Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.
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Affiliation(s)
- Katharine M. Gary
- Duke University, Durham, NC, USA
- Katharine Gary, Duke University, Erwin Mill
Building, 2024 W. Main Street, Durham, NC 27705, USA.
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Rubin L, Ingram LA, Resciniti NV, Ashford-Carroll B, Leith KH, Rose A, Ureña S, McCollum Q, Friedman DB. Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review. Front Public Health 2021; 9:784958. [PMID: 35004586 PMCID: PMC8739784 DOI: 10.3389/fpubh.2021.784958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.
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Affiliation(s)
- Lindsey Rubin
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Brianna Ashford-Carroll
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Katherine Henrietta Leith
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Aubrey Rose
- School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Stephanie Ureña
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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Luo J, Dinh P, Hendryx M, Li W, Robinson J, Margolis KL. Risk Patterns and Mortality in Postmenopausal Women Using Latent Class Analysis. Am J Prev Med 2021; 61:e225-e233. [PMID: 34686303 PMCID: PMC8542102 DOI: 10.1016/j.amepre.2021.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although risk factors often co-occur, previous studies examining lifestyle or psychosocial factors often treat these factors as individual predictors of health. This study aims to identify the underlying subgroups of women characterized by distinct lifestyle and psychosocial risk patterns and to investigate the prospective associations between risk patterns and mortality among postmenopausal women. METHODS A total of 64,812 postmenopausal women aged 50-79 years without prevalent diabetes, cardiovascular disease, and cancer at baseline (1993-1998) were followed until 2019 with a mean follow-up duration of 14.6 (SD=6.4) years. Latent class analysis was used to identify the latent classes of women with homogeneous combinations of lifestyle and psychosocial variables and to test whether the classes were prospectively associated with mortality. Analyses were stratified by race/ethnicity and were performed in 2020. RESULTS A total of 4 latent classes (Healthy Lifestyle and Psychosocial, Risky Psychosocial, Risky Lifestyle, and Risky Lifestyle and Risky Psychosocial) were identified for Hispanic, Black, and White women, and 2 classes (High Risk or Low Risk) were identified for American Indian and Asian women. Women in the Risky Lifestyle and Risky Psychosocial group had the highest hazard ratios for all outcomes studied for all race/ethnicity groups than those in the Healthy Lifestyle and Psychosocial group, followed by those in the Risky Lifestyle group. Risky Psychosocial class was significantly associated with an elevated risk of overall and cardiovascular disease mortality only in Black women. CONCLUSIONS The class with concurrent risky lifestyle and psychosocial factors conveyed the greatest risk of all types of mortality than a low-risk ref group. Health promotion should address both behavioral and psychosocial risks concurrently.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana.
| | - Paul Dinh
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Wenjun Li
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Jennifer Robinson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
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Letang SK, Lin SSH, Parmelee PA, McDonough IM. Ethnoracial disparities in cognition are associated with multiple socioeconomic status-stress pathways. Cogn Res Princ Implic 2021; 6:64. [PMID: 34626254 PMCID: PMC8502192 DOI: 10.1186/s41235-021-00329-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
Systemic racism can have broad impacts on health in ethnoracial minorities. One way is by suppressing socioeconomic status (SES) levels through barriers to achieve higher income, wealth, and educational attainment. Additionally, the weathering hypothesis proposes that the various stressful adversities faced by ethnoracial minorities lead to greater wear and tear on the body, known as allostatic load. In the present study, we extend these ideas to cognitive health in a tri-ethnic sample of young adults-when cognition and brain health is arguably at their peak. Specifically, we tested competing mediation models that might shed light on how two key factors caused by systemic racism-SES and perceived stress-intersect to explain ethnoracial disparities in cognition. We found evidence for partial mediation via a pathway from SES to stress on episodic memory, working memory capacity, and executive function in Black Americans relative to non-Hispanic White Americans. Additionally, we found that stress partially mediated the ethnoracial disparities in working memory updating for lower SES Black and Hispanic Americans relative to non-Hispanic White Americans, showing that higher SES can sometimes reduce the negative effects stress has on these disparities in some cognitive domains. Overall, these findings suggest that multiple pathways exist in which lower SES creates a stressful environment to impact ethnoracial disparities cognition. These pathways differ depending on the specific ethnoracial category and cognitive domain. The present results may offer insight into strategies to help mitigate the late-life risk for neurocognitive disorders in ethnoracial minorities.
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Affiliation(s)
- Sarah K Letang
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA
| | - Shayne S-H Lin
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA
| | - Patricia A Parmelee
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA
- Alabama Research Institute on Aging, Tuscaloosa, USA
| | - Ian M McDonough
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA.
- Alabama Research Institute on Aging, Tuscaloosa, USA.
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Wright KD, Lin CJ, Cothran FA, Williams KP. Beyond Allostatic Load: Focused Biological Measures of Chronic Stress in African American Older Adults. Res Gerontol Nurs 2021; 14:222-224. [PMID: 34542346 DOI: 10.3928/19404921-20210825-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kathy D Wright
- Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, Discovery Themes-Chronic Brain Injury Program, Columbus, Ohio
| | - Chyongchiou J Lin
- Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University College of Nursing, Columbus, Ohio
| | - Fawn A Cothran
- Family Caregiving Institute at the Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University College of Nursing, Columbus, Ohio
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45
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John A, Ali K, Marsh H, Reddy PH. Can healthy lifestyle reduce disease progression of Alzheimer's during a global pandemic of COVID-19? Ageing Res Rev 2021; 70:101406. [PMID: 34242809 PMCID: PMC8259043 DOI: 10.1016/j.arr.2021.101406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/05/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) has pushed the medical system to its breaking point. While the virus does not discriminate, the elderly and those with comorbidities, including hypertension severe obesity, diabetes mellitus, coronary disease, pneumonia and dementia, are at a greater risk for adverse outcomes due to COVID-19. While many people navigate their new normal, the question of what the long-lasting effects of the pandemic may be, lingers. To investigate how vulnerable populations are affected by the pandemic, we focused on Alzheimer's disease, a vector to understanding how the virus has impacted AD progression and risk via aging. By assessing the effect of COVID-19 on AD patients, we explore genetics, metabolism, and lifestyle factors in both COVID-19 and Alzheimer's disease that can work synergistically to precipitate adverse outcomes. This article also discusses how age-related conditions and/or age-related comorbidities susceptible to COVID-19. We also discuss possible healthy lifestyle factors reduce and/or combat COVID-19 now and in the future.
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Affiliation(s)
- Albin John
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kiran Ali
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Harrison Marsh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Neuroscience & Pharmacology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Evans E, Coley SL, Gooding DC, Norris N, Ramsey CM, Green-Harris G, Mueller KD. Preliminary assessment of connected speech and language as marker for cognitive change in late middle-aged Black/African American adults at risk for Alzheimer's disease. APHASIOLOGY 2021; 36:982-1005. [PMID: 36016839 PMCID: PMC9398189 DOI: 10.1080/02687038.2021.1931801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 05/03/2021] [Indexed: 06/15/2023]
Abstract
Background Connected speech-language (CSL) has been a promising measure of assessing cognitive decline in populations at-risk for Alzheimer's disease and related dementias (ADRD) populations. A common way to obtain CSL is through using picture description tasks such as the most frequently used image Cookie Theft (CT). However, questions have been raised about using CT for diverse communities. Little is known about the CSL produced in response to this task in Black/African American (BAA) adults aged 48-74. Goals The present study's goals were to characterize CSL in BAA adults by sex and APOE-ε4 status from Milwaukee in the Wisconsin Registry for Alzheimer's Prevention (WRAP) study when presented with the CT picture description task and to identify differences in CSL output between BAAs and non-Hispanic Whites (NHW). Methods and Procedures We collected CSL samples from the CT picture from 48 BAA participants and 30 NHW participants from the WRAP participants in Milwaukee, WI group. CSL was analyzed using chi-square tests, T-tests, and ANCOVA. Linear mixed effect regression models were used to determine the association between cognitive status and longitudinal CSL in BAA participants with more than 1 timepoint. Outcomes and Results Declines in CSL of BAA participants were associated with subtle declines in cognition. Among BAA participants, we found no significant differences in speech measures in terms of sex and APOE-ε4 status. Our results showed no significant differences in speech measures between BAA and NHW groups. Conclusions CSL analysis provides an inexpensive way to evaluate preclinical changes in cognitive status that may not be as affected by other factors, such as ethnocultural background. Future studies with larger sample sizes and participants from other geographic locations can clarify these findings.
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Affiliation(s)
- Elizabeth Evans
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sheryl L Coley
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Diane C Gooding
- Department of Psychology and Psychiatry, University of Wisconsin-Madison, Madison, WI University of Wisconsin, Madison, Wisconsin, USA
| | - Nia Norris
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Celena M Ramsey
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gina Green-Harris
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kimberly D Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Wisconsin, USA
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Meza E, Peterson R, Gilsanz P, George KM, Miles SJ, Eng CW, Mungas DM, Mayeda ER, Glymour MM, Whitmer RA. Perceived Discrimination, Nativity, and Cognitive Performance in a Multi-ethnic Study of Older Adults: Findings from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study. J Gerontol A Biol Sci Med Sci 2021; 77:e65-e73. [PMID: 34125189 PMCID: PMC8824601 DOI: 10.1093/gerona/glab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite growing research on the association between discrimination and disparities in cognitive aging, an evidence gap remains on how the association varies by racial/ethnic group. This study evaluates the associations of experiences of discrimination with cognitive function and whether these associations varied by race/ethnicity and nativity. METHODS Using the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) cohort (N=1,712) with approximately equal groups of Black, White, Latino, and Asian community-dwelling older adults aged 65 years and older, we evaluated the associations between self-reported experiences of everyday and major lifetime discrimination with overall cognitive performance and domain-specific cognition (verbal episodic memory, semantic memory and executive functioning) across race/ethnicity and nativity. Linear regression models examined the cross-sectional association between self-reported experiences of everyday and major lifetime discrimination with z-standardized coefficients for cognition. We tested for effect modification by race and nativity. All models controlled for age, sex and education. RESULTS Among KHANDLE participants (mean age: 76 years; standard deviation: 6.8), everyday discrimination was not associated with cognitive scores. Major lifetime discrimination was associated with better average cognitive scores among Black participants but not among other racial/ethnic groups. Major lifetime discrimination was associated with better average cognitive scores among US-born but not among non-US born individuals. CONCLUSION Our findings do not imply that discrimination improves cognition, but rather suggest that future research should include more detailed measures on discrimination and unfair treatment that could help disentangle the extent to which relationships are causal or reflect some other underlying factor.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA
| | - Rachel Peterson
- Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Sunita J Miles
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chloe W Eng
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dan M Mungas
- Department of Neurology, University of California, Davis, Davis, CA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis, Davis, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Hunt JFV, Vogt NM, Jonaitis EM, Buckingham WR, Koscik RL, Zuelsdorff M, Clark LR, Gleason CE, Yu M, Okonkwo O, Johnson SC, Asthana S, Bendlin BB, Kind AJH. Association of Neighborhood Context, Cognitive Decline, and Cortical Change in an Unimpaired Cohort. Neurology 2021; 96:e2500-e2512. [PMID: 33853894 DOI: 10.1212/wnl.0000000000011918] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that neighborhood-level disadvantage is associated with longitudinal measures of neurodegeneration and cognitive decline in an unimpaired cohort. METHODS Longitudinal MRI and cognitive testing data were collected from 601 cognitively unimpaired participants in the Wisconsin Registry for Alzheimer's Prevention Study and the Wisconsin Alzheimer's Disease Research Center clinical cohort. Area Deprivation Index was geospatially determined based on participant residence geocode and ranked relative to state of residence. Linear regression models were fitted to test associations between neighborhood-level disadvantage and longitudinal change in cortical thickness and cognitive test performance. Mediation tests were used to assess whether neurodegeneration and cognitive decline were associated with neighborhood-level disadvantage along the same theoretical causal path. RESULTS In our middle- to older-aged study population (mean baseline age 59 years), living in the 20% most disadvantaged neighborhoods (n = 19) relative to state of residence was associated with cortical thinning in Alzheimer signature regions (p = 0.002) and decline in the Preclinical Alzheimer's Disease Cognitive Composite (p = 0.04), particularly the Trail-Making Test, part B (p < 0.001), but not Rey Auditory Verbal Learning Test (p = 0.77) or Story Memory Delayed Recall (p = 0.49) subtests. Associations were attenuated but remained significant after controlling for racial and demographic differences between neighborhood-level disadvantage groups. Cortical thinning partially mediated the association between neighborhood-level disadvantage and cognitive decline. CONCLUSIONS In this longitudinal study of cognitively unimpaired adults, living in the most highly disadvantaged neighborhoods was associated with accelerated degeneration in Alzheimer signature regions and cognitive decline. This study provides further evidence for neighborhood-level disadvantage as a risk factor for preclinical neurodegeneration and cognitive decline in certain populations. Limitations of the present study, including a small number of participants from highly disadvantaged neighborhoods and a circumscribed geographic setting, should be explored in larger and more diverse study cohorts.
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Affiliation(s)
- Jack F V Hunt
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Nicholas M Vogt
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Erin M Jonaitis
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - William R Buckingham
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Rebecca L Koscik
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Megan Zuelsdorff
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Lindsay R Clark
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Carey E Gleason
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Menggang Yu
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Ozioma Okonkwo
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Sterling C Johnson
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Sanjay Asthana
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI
| | - Barbara B Bendlin
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI.
| | - Amy J H Kind
- From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI.
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Deters KD, Napolioni V, Sperling RA, Greicius MD, Mayeux R, Hohman T, Mormino EC. Amyloid PET Imaging in Self-Identified Non-Hispanic Black Participants of the Anti-Amyloid in Asymptomatic Alzheimer's Disease (A4) Study. Neurology 2021; 96:e1491-e1500. [PMID: 33568538 DOI: 10.1212/wnl.0000000000011599] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether amyloid PET in cognitively normal (CN) individuals screened for the Anti-Amyloid in Asymptomatic Alzheimer's Disease (A4) study differed across self-identified non-Hispanic White and Black (NHW and NHB) groups. METHODS We examined 3,689 NHW and 144 NHB participants who passed initial screening for the A4 study and underwent amyloid PET. The effect of race on amyloid PET was examined using logistic (dichotomous groups) and linear (continuous values) regression controlling for age, sex, and number of APOE ε4 and APOE ε2 alleles. Associations between amyloid and genetically determined ancestry (reflecting African, South Asian, East Asian, American, and European populations) were tested within the NHB group. Potential interactions with APOE were assessed. RESULTS NHB participants had lower rates of amyloid positivity and lower continuous amyloid levels compared to NHW participants. This race effect on amyloid was strongest in the APOE ε4 group. Within NHB participants, those with a lower percentage of African ancestry had higher amyloid. A greater proportion of NHB participants did not pass initial screening compared to NHW participants, suggesting potential sources of bias related to race in the A4 PET data. CONCLUSION Reduced amyloid was observed in self-identified NHB participants who passed initial eligibility criteria for the A4 study. This work stresses the importance of investigating AD biomarkers in ancestrally diverse samples as well as the need for careful consideration regarding study eligibility criteria in AD prevention trials.
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Affiliation(s)
- Kacie D Deters
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN.
| | - Valerio Napolioni
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN
| | - Reisa A Sperling
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN
| | - Michael D Greicius
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN
| | - Richard Mayeux
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN
| | - Timothy Hohman
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN
| | - Elizabeth C Mormino
- From the Department of Neurology and Neurological Sciences (K.D.D., V.N., M.D.G., E.C.M.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology (R.A.S.), Brigham and Women's Hospital, Massachusetts General Hospital, Boston; Department of Neurology, The Taub Institute for Research on Alzheimer's Disease and The Aging Brain, and The Institute for Genomic Medicine (R.M.), Columbia University Medical Center and The New York Presbyterian Hospital, New York; and Vanderbilt Memory and Alzheimer's Center and Vanderbilt Genetics Institute (T.H.), Nashville, TN
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50
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Storr CL, Reboussin BA, Green KM, Mojtabai R, Susukida R, Young AS, Cullen BA, Alvanzo AAH, Crum RM. Stressful life events and transitions in problematic alcohol use involvement among US adults. Subst Use Misuse 2021; 56:2171-2180. [PMID: 34523388 DOI: 10.1080/10826084.2021.1975748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We investigated the impact of stressful life events (SLEs) for males and females on transitions in problematic alcohol involvement, both progression and recovery, over a 3-year interval. METHOD Participants of both Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were stratified by sex (14,233 males and 19,550 females). Latent transition analysis estimated the impact of experiencing ≥3 SLE in the year preceding the Wave 1 interview on the probability of transitioning between three empirically-derived stages of alcohol involvement (patterns of alcohol use disorder [AUD] symptoms), across waves. Propensity score methods adjusted for confounding. RESULTS For males, three or more SLEs were associated with progression from the moderate to the severe problem stage (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 1.17, 4.26). Among those in the severe problem stage, SLEs negatively impacted recovery regardless of sex. Employment/Financial SLEs were associated with a higher odds of transition from the moderate to the no problem stage (OR = 1.60, 95% CI = 1.03, 2.46) and lower odds of transitions from the severe to the moderate problem stage (OR = 0.40, 95% CI = 0.16, 0.99) among males, and from the severe to the no problem stage (OR = 0.26, 95% CI = 0.07, 0.88) among females. CONCLUSION Stressful life events appear to affect transitions in alcohol involvement over time among those who already have alcohol problems, rather than impacting a transition among those without AUD problems.
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Affiliation(s)
- Carla L Storr
- Department of Family and Community Health, University of Maryland Baltimore School of Nursing, Baltimore, MD, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland College Park School of Public Health, College Park, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bernadette A Cullen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | | | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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