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Gleason CE, Norton D, Zuelsdorff M, Benton SF, Wyman MF, Nystrom N, Lambrou N, Salazar H, Koscik RL, Jonaitis E, Carter F, Harris B, Gee A, Chin N, Ketchum F, Johnson SC, Edwards DF, Carlsson CM, Kukull W, Asthana S. Association between enrollment factors and incident cognitive impairment in Blacks and Whites: Data from the Alzheimer's Disease Center. Alzheimers Dement 2019; 15:1533-1545. [PMID: 31601516 PMCID: PMC6925619 DOI: 10.1016/j.jalz.2019.07.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/02/2019] [Accepted: 07/14/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We examined the influence of enrollment factors demonstrated to differ by race on incident mild cognitive impairment and dementia using Alzheimer's Disease Center data. METHODS Differences in rates of incident impairment between non-Latino Whites and Blacks (n = 12,242) were examined with age-at-progression survival models. Models included race, sex, education, source of recruitment, health factors, and family history of dementia. RESULTS No significant race differences in progression were observed in cognitively unimpaired participants. In those with mild cognitive impairment at baseline, Whites evidenced greater risk for progression than Blacks. Enrollment factors, for example, referral source, were significantly related to progression. DISCUSSION The finding that Blacks demonstrated lower rate of progression than Whites is contrary to the extant literature. Nested-regression analyses suggested that selection-related factors, differing by race, may account for these findings and influence our ability to accurately estimate risk for progression. It is potentially problematic to make racial comparisons using Alzheimer's Disease Center data sets.
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Affiliation(s)
- Carey E Gleason
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Derek Norton
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Megan Zuelsdorff
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Susan F Benton
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary F Wyman
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Naomi Nystrom
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Minnesota Department of Human Services, MN, USA
| | - Nickolas Lambrou
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Hector Salazar
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Rebecca L Koscik
- Department of Medicine, Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erin Jonaitis
- Department of Medicine, Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fabu Carter
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Brieanna Harris
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Alexander Gee
- Nehemiah Center for Urban Leadership Development, Madison, WI, USA
| | - Nathaniel Chin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Frederick Ketchum
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Medicine, Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dorothy F Edwards
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Department of Kinesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Medicine, Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Walter Kukull
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; National Alzheimer's Coordinating Center, Seattle, WA, USA
| | - Sanjay Asthana
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Medicine, Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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