"Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black

Introduction

Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies.

Methods

We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models.

Results

Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts.

Discussion

These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Contribution of Global Amyloid-PET Imaging for Predicting Future Cognition in the MEMENTO Cohort

BACKGROUND AND OBJECTIVES

Global amyloid-PET is associated with cognition and cognitive decline, but most research on this association does not account for past cognitive information. We assessed the prognostic benefit of amyloid-PET measures for future cognition when prior cognitive assessments are available, evaluating the added value of amyloid measures beyond information on multiple past cognitive assessments.

METHODS

The French MEMENTO cohort (a cohort of outpatients from French research memory centers to improve knowledge on Alzheimer disease and related disorders) includes older outpatients with incipient cognitive changes, but no dementia diagnosis at inclusion. Global amyloid burden was assessed using positron emission tomography (amyloid-PET) for a subset of participants; semiannual cognitive testing was subsequently performed. We predicted mini-mental state examination (MMSE) scores using demographic characteristics (age, sex, marital status, and education) alone or in combination with information on prior cognitive measures. The added value of amyloid burden as a predictor in these models was evaluated with percent reduction of the mean squared error (MSE). All models were conducted separately for evaluating the added value of dichotomous amyloid positivity status compared with a continuous amyloid-standardized uptake-value ratio.

RESULTS

Our analytic sample comprised 510 individuals who underwent amyloid-PET scans with at least 4 MMSE assessments. The mean age at the PET scan was 71.6 (standard deviation 7.4) years; 60.7% were female. The median follow-up was 4.6 years (interquartile range: 0.9 years). Adding amyloid burden when adjusting for only demographic characteristics reduced the MSE of predictions by 5.08% (95% CI 0.97%-10.86%) and 12.64% (95% CI 3.35%-25.28%) for binary and continuous amyloid, respectively. If the model included 1 past MMSE measure, the MSE improvement was 3.51% (95% CI 1.01%-7.28%) when adding binary amyloid and 8.83% (95% CI 2.63%-16.37%) when adding continuous amyloid. Improvements in model fit were smaller with the addition of amyloid burden when more than 1 past cognitive assessment was included. For all models incorporating past cognitive assessments, differences in predictions amounted to a fraction of 1 MMSE point on average.

DISCUSSION

In a clinical setting, global amyloid burden did not appreciably improve cognitive predictions when past cognitive assessments were available.

TRIAL REGISTRATION INFORMATION

ClinicalTrials.gov Identifier: NCT02164643.

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.

Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing

BACKGROUND AND OBJECTIVES

Rapid developments in Alzheimer disease (AD) biomarker research suggest that predictive testing may become widely available. To ensure equal access to AD predictive testing, it is important to understand factors that affect testing interest. Discrimination may influence attitudes toward AD testing, particularly among racially and ethnically minoritized populations, because of structural racism in health care systems. This study examined whether everyday or lifetime discrimination experiences shape interest in AD predictive testing.

METHODS

In the 2010 and 2012 biennial Health and Retirement Study waves, respondents were randomly selected to complete questions on interest in receiving free testing that could determine whether they would develop AD in the future. The exposures were everyday discrimination (6 items) and lifetime discrimination (7 items); both were transformed into a binary variable. Logistic regression models predicting interest in AD testing were controlled for deciles of propensity scores for each discrimination measure. Odds ratios were re-expressed as risk differences (RDs).

RESULTS

Our analytic sample included 1,499 respondents. The mean age was 67 (SD = 10.2) years, 57.4% were women, 65.7% were White, and 80% endorsed interest in AD predictive testing. Most of the participants (54.7%) experienced everyday discrimination in at least one domain; 24.1% experienced major lifetime discrimination in at least one domain. Those interested in predictive testing were younger (66 vs 70 years) and more likely to be Black (20% vs 15%) or Latinx (14% vs 8%) than participants uninterested in testing. The probability of wanting an AD test was not associated with discrimination for Black (RD everyday discrimination = -0.026; 95% CI [-0.081 to 0.029]; RD lifetime discrimination = -0.012; 95% CI [-0.085 to 0.063]) or Latinx (RD everyday discrimination = -0.023, 95% CI [-0.082 to 0.039]; RD lifetime discrimination = -0.011; 95% CI [-0.087 to 0.064]) participants.

DISCUSSION

Despite historical and contemporary experiences of discrimination, Black and Latinx individuals express interest in AD testing. However, Black and Latinx individuals remain underrepresented in AD research, including research on AD testing. Interest in personalized information about dementia risk may be a pathway to enhance their inclusion in research and clinical trials.

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

Importance

Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association.

Objective

To examine whether food insecurity in older adults is associated with later-life cognitive outcomes.

Design, Setting, and Participants

This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023.

Exposure

Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure.

Main Outcomes and Measures

Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights.

Results

The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline.

Conclusions and Relevance

In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

Riding the merry-go-round of racial disparities in ADRD research

INTRODUCTION

With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized groups who are at disproportionately higher risk. To date, research emphasis has been on further characterizing the existence of racial disparities in ADRD through comparisons to groups racialized as White that are assumed to be normative. Much of the literature on this comparison insinuates that racialized and minoritized groups experience poorer outcomes due to genetics, culture, and/or health behaviors.

METHODS

This perspective shines a light on a category of ADRD research that employs ahistorical methodological approaches to describe racial disparities in ADRD that puts us on a merry-go-round of research with no benefits to society.

METHODS

This commentary provides historical context for the use of race in ADRD research and justification for the study of structural racism. The commentary concludes with recommendations to guide future research.

The Black radical imagination: a space of hope and possible futures

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.

Exploring factors contributing to caregiver burden in family caregivers of congolese adults with suspected dementia

INTRODUCTION

Predicting caregiver burden in individuals with suspected dementia - is critical due to the debilitating nature of these disorders and need for caregiver support. While some examination of the factors affecting burden has been undertaken in Sub-Saharan Africa, each country presents with its own unique challenges and obstacles. This pilot study investigates predictors of caregiver burden in family caregivers of individuals with suspected dementia living in the Democratic Republic of the Congo (DRC).

METHODS

Linear and multiple regression analyses were conducted to explore factors associated with caregiver burden in 30 patient-caregiver dyads with the Zarit Burden Interview (ZBI) for caregiver burden evaluation. Cognitive impairments of patients were assessed using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire (AQ), the African Neuropsychology Battery, and the Neuropsychiatric Symptoms Inventory (NPI).

RESULTS

Average caregiver burden on the ZBI was 36.1 (SD = 14.6; range = 12-58). Greater impairments in patient cognition (orientation, visuospatial, memory, executive functioning), fragility, and neuropsychiatric symptoms (delirium, agitation, depression) were predictive of caregiver burden. After controlling for AQ scores and caregiver gender, greater symptoms of depression, and worse performances on verbal memory and problem solving were associated with greater caregiver burden.

CONCLUSION

Worsening patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. These findings are consistent with the prior literature. Future studies may wish to explore supportive factors and caregiver specific characteristics that buffer against perceived burden.

The structural and social determinants of Alzheimer's disease related dementias

INTRODUCTION

The projected growth of Alzheimer's disease (AD) and AD-related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD.

METHODS

In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes.

RESULTS

Bronfenbrenner defined the "macrosystem" as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper.

DISCUSSION

Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research.

HIGHLIGHTS

Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro-level determinants have been understudied in the AD/ADRD literature.

A developmental approach to diversifying neuroscience through effective mentorship practices: perspectives on cross-identity mentorship and a critical call to action

Many early-career neuroscientists with diverse identities may not have mentors who are more advanced in the neuroscience pipeline and have a congruent identity due to historic biases, laws, and policies impacting access to education. Cross-identity mentoring relationships pose challenges and power imbalances that impact the retention of diverse early career neuroscientists, but also hold the potential for a mutually enriching and collaborative relationship that fosters the mentee's success. Additionally, the barriers faced by diverse mentees and their mentorship needs may evolve with career progression and require developmental considerations. This article provides perspectives on factors that impact cross-identity mentorship from individuals participating in Diversifying the Community of Neuroscience (CNS)-a longitudinal, National Institute of Neurological Disorders and Stroke (NINDS) R25 neuroscience mentorship program developed to increase diversity in the neurosciences. Participants in Diversifying CNS were comprised of 14 graduate students, postdoctoral fellows, and early career faculty who completed an online qualitative survey on cross-identity mentorship practices that impact their experience in neuroscience fields. Qualitative survey data were analyzed using inductive thematic analysis and resulted in four themes across career levels: (1) approach to mentorship and interpersonal dynamics, (2) allyship and management of power imbalance, (3) academic sponsorship, and (4) institutional barriers impacting navigation of academia. These themes, along with identified mentorship needs by developmental stage, provide insights mentors can use to better support the success of their mentees with diverse intersectional identities. As highlighted in our discussion, a mentor's awareness of systemic barriers along with active allyship are foundational for their role.

The Role of Coping in the Relationship Between Endorsement of the Strong Black Woman Schema and Depressive Symptoms Among Black Women

The Strong Black Woman (SBW) schema has been consistently linked to negative mental health outcomes among Black women. However, few have begun to explicate the mechanisms by which the endorsement of the SBW schema may influence mental health outcomes. Accordingly, the current study examined coping styles (social support, disengagement, spirituality, and problem-oriented/engagement) as mediators in the association between endorsement of the SBW schema and depressive symptoms in a sample of Black women. Data from 240 Black women ( Mage = 22.0, SD = 4.0 years) were collected assessing SBW schema endorsement, coping styles, and depressive symptoms. Parallel multiple mediation analysis was conducted using PROCESS Macro. Of the four coping styles examined, disengagement coping partially mediated the association between greater endorsement of the SBW schema and greater depressive symptoms. Study findings add depth to our understanding of the association between the SBW schema and mental health outcomes and lend themselves to research and clinical implications.

Gendered racism and subjective cognitive complaints among older black women: The role of depression and coping

Objective: Psychosocial stress is a risk factor for cognitive impairment and a potential pathway through which disparities in cognitive functioning emerge and disproportionately disadvantage older Black adults. Gendered racism is a psychosocial stressor that has negative implications for Black women's mental and physical health. This study tested the association between lifetime experiences of gendered racism and subjective cognitive complaints, taking into account the extent to which depressive symptoms and coping styles may explain this association. Method: Data from 75 older Black women (M_age = 62.43, SD = 6.23 years) were collected using an online survey assessing lifetime experiences of gendered racism, depressive symptoms, coping styles (i.e. spirituality, social support, problem-oriented/engagement, and disengagement), and subjective cognitive complaints (i.e. memory, attention, executive functioning, language, and overall cognition). The association between gendered racism and subjective cognitive complaints was examined with simple linear regression. Two mediation models examined depressive symptoms and coping styles as independent mediators of this association. Results: More gendered racism across the lifetime was associated with more subjective cognitive complaints separately through depressive symptoms and disengagement coping, but no other coping styles. Conclusion: Gendered racism is linked to increased subjective cognitive complaints via depressive symptoms and disengagement coping. The study highlights the importance of taking into account lived experiences (gendered racism) that are inextricably linked to social positioning (race and gender) within neuropsychology. Results evidence the negative impact of psychosocial stress, specifically gendered racism, on older Black women's subjective cognitive functioning, and illuminate avenues for clinical intervention and social justice advocacy.

Does Literacy Moderate the Relationship between Age of Migration and Cognitive Change: Results from the Washington Heights-Inwood Community Aging Project (WHICAP)

Objective

The “healthy immigrant effect” pertains to findings that Hispanics/Latinos born outside of the US tend to be physically and emotionally healthier than individuals born in the US. However, immigrant Latino groups residing in the US have higher incidences of dementia (Tang et al., 2001). Sex/gender and years of education have been found to moderate the relationship between age of migration and cognitive functioning among immigrants born in Mexico (Garcia et al., 2017; Hill et al., 2012). While years of education has been the focus of many studies, literacy (ability to read/write) has been less frequently explored as a moderator of age of migration and cognitive change. We investigated the effect of age of migration on cognitive trajectory in a diverse Latino population and explored whether literacy influences the association between age of immigration and cognitive change. We hypothesize that literacy (ability to read/write) will buffer the effects of age of migration on cognitive (memory, language, motor speed, visuospatial) trajectory.

Participants and Method

Age at baseline, English fluency, country of birth, sex/gender, and years of education were included as time-invariant covariates and literacy was tested as a moderator via multiple group modeling.

Results

Results show that age of migration is marginally and inversely associated with baseline cognitive performance (p < .01). Thus, individuals who immigrated at an older age had lower baseline cognitive scores than their counterparts. Age of migration was not associated with cognitive change. Independent of covariates, literacy did not buffer the negative effects of later age at migration on cognitive function.

Conclusions

Results suggest that literacy confers a small advantage in premorbid cognition, but does not protect against cognitive decline over time. These findings also suggest that adults who immigrate at an older age present with lower cognitive scores at baseline, but do not experience faster rates of cognitive change.

References

Tang, M. X., Cross, P., Andrews, H., Jacobs, D. M., Small, S., Bell, K., ... & Mayeux, R. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 49-56. Garcia, M. A., Reyes, A. M., Downer, B., Saenz, J. L., Samper-Ternent, R. A., & Raji, M. (2018). Age of migration and the incidence of cognitive impairment: A cohort study of elder Mexican-Americans. Innovation in aging, 1, igx037. https://doi.org/10.1093/geroni/igx037. Hill, T. D., Angel, J. L., Balistreri, K. S., & Herrera, A. P. (2012). Immigrant Status and Cognitive Functioning in Late Life: An Examination of Gender Variations in the Healthy Immigrant Effect. Social Science & Medicine (1982), 75, 2076–2084. http://doi.org/10.1016/j.socscimed.2012.04.005.

Visuospatial attention after traumatic brain injury: The role of hemispheric specialization

PRIMARY OBJECTIVE

To evaluate the behavioural and neural effects of TBI on the hemispheric integrity of three components of visuospatial attention: alerting, orienting and executive control.

METHOD

Behavioural performance and high density event-related potentials (ERPs) were acquired while a sample of 12 patients with chronic moderate-to-severe TBI and 12 controls performed the Lateralized Attention Network Test (LANT). Neural indices of attention (posterior N1 amplitude to alerting and orienting cues, midline P3 amplitude during conflict resolution) were examined.

RESULTS

Patients with TBI exhibited smaller N1 amplitude to alerting cues, but comparable behavioural performance to controls. Participants with TBI also demonstrated poorer orienting performance to the left hemispace relative to the right. A corresponding reduction in right hemisphere N1 was found during left orienting to spatial cues in the TBI group. No group differences were observed on behavioural measures of executive control; however, patients with TBI exhibited reduced P3 amplitude overall.

CONCLUSIONS

TBI may have an enduring effect on the orienting system at both neural and behavioural levels. Assessment of attention in chronic TBI can be improved by the integration of hemispheric findings that suggest disproportionate vulnerability in leftward orienting. Results may enhance clinical sensitivity to detection of subtle signs of neglect.