Cognitive Trajectories and Associated Social and Behavioral Determinants Among Racial/Ethnic Minority Older Adults in the United States

Overview

Journal Gerontologist

Publisher Oxford University Press

Specialty Geriatrics

Date 2024 Oct 15

PMID 39403721

Authors

Kun Wang

Xiayu Summer Chen

Xiaoyi Zeng

Bei Wu

Jinyu Liu

Jane Daquin

Clara Li

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Despite higher risks of developing Alzheimer's disease and Alzheimer's disease-related dementias among racial/ethnic minority populations, some maintain good cognition until old age. The aims of this study were to investigate heterogeneous cognitive trajectories among non-Hispanic Black and Hispanic older adults, examine cognitive impairment prevalence across trajectory classes, and identify associated social and behavioral determinants.

Research Design And Methods: Using 11 waves of data from the Health and Retirement Study (1996-2016), 1,322 non-Hispanic Black and 747 Hispanic adults aged 50+ years in 1996 with normal cognition were included. Latent class growth modeling and multinomial logistic regressions were performed to examine cognitive trajectories and associated determinants.

Results: For both racial/ethnic groups, 3 trajectory classes were identified: high, medium, and low cognition. In the low-cognition class, 87% and 100% of non-Hispanic Black and Hispanic participants, respectively, developed cognitive impairment. For both racial/ethnic groups, older age and living in rural areas during schooltime increased the likelihood of being in the low-cognition class, whereas more education was associated with a lower likelihood. Unique risk and protective determinants for non-Hispanic Black and Hispanic participants were also identified.

Discussion And Implications: This study reveals the heterogeneity of cognitive trajectories among racial/ethnic minority older adults and various associated social and behavioral determinants. More prevention interventions and accessible, affordable diagnosis and treatment should be provided to older racial/ethnic minorities with these characteristics to reduce disparities. More research is needed to further explore associations between unique determinants and cognition in racial/ethnic minority populations to better inform interventions.

References

Zaganas I, Kapetanaki S, Mastorodemos V, Kanavouras K, Colosio C, Wilks M . Linking pesticide exposure and dementia: what is the evidence?. Toxicology. 2013; 307:3-11. DOI: 10.1016/j.tox.2013.02.002. View

Rodriguez F, Saenz J . Working in old age in Mexico: Implications for Cognitive Functioning. Ageing Soc. 2022; 42(11):2489-2509. PMC: 9782718. DOI: 10.1017/s0144686x2100012x. View

Vasquez E, Botoseneanu A, Bennett J, Shaw B . Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults. J Aging Health. 2016; 28(8):1382-1402. DOI: 10.1177/0898264315620589. View

Wu Z, Woods R, Wolfe R, Storey E, Chong T, Shah R . Trajectories of cognitive function in community-dwelling older adults: A longitudinal study of population heterogeneity. Alzheimers Dement (Amst). 2021; 13(1):e12180. PMC: 8088593. DOI: 10.1002/dad2.12180. View

Zammit A, Hall C, Lipton R, Katz M, Muniz-Terrera G . Identification of Heterogeneous Cognitive Subgroups in Community-Dwelling Older Adults: A Latent Class Analysis of the Einstein Aging Study. J Int Neuropsychol Soc. 2018; 24(5):511-523. PMC: 6484858. DOI: 10.1017/S135561771700128X. View

Choi E, Kim S, Zahodne L, Albert S . Older Workers with Physically Demanding Jobs and their Cognitive Functioning. Ageing Int. 2021; 47(1):55-71. PMC: 7791149. DOI: 10.1007/s12126-020-09404-8. View

Bowen M . Childhood socioeconomic status and racial differences in disability: evidence from the Health and Retirement Study (1998-2006). Soc Sci Med. 2009; 69(3):433-41. DOI: 10.1016/j.socscimed.2009.06.006. View

Laukka E, MacDonald S, Fratiglioni L, Backman L . Preclinical cognitive trajectories differ for Alzheimer's disease and vascular dementia. J Int Neuropsychol Soc. 2012; 18(2):191-9. DOI: 10.1017/S1355617711001718. View

Hayden K, Reed B, Manly J, Tommet D, Pietrzak R, Chelune G . Cognitive decline in the elderly: an analysis of population heterogeneity. Age Ageing. 2011; 40(6):684-9. PMC: 3199215. DOI: 10.1093/ageing/afr101. View

10.

Lamar M, Lerner A, James B, Yu L, Glover C, Wilson R . Relationship of Early-Life Residence and Educational Experience to Level and Change in Cognitive Functioning: Results of the Minority Aging Research Study. J Gerontol B Psychol Sci Soc Sci. 2019; 75(7):e81-e92. PMC: 7424266. DOI: 10.1093/geronb/gbz031. View

11.

Zahodne L, Wall M, Schupf N, Mayeux R, Manly J, Stern Y . Late-life memory trajectories in relation to incident dementia and regional brain atrophy. J Neurol. 2015; 262(11):2484-90. PMC: 4819990. DOI: 10.1007/s00415-015-7871-8. View

12.

Howrey B, Raji M, Masel M, Peek M . Stability in Cognitive Function Over 18 Years: Prevalence and Predictors among Older Mexican Americans. Curr Alzheimer Res. 2015; 12(7):614-21. PMC: 5501462. DOI: 10.2174/1567205012666150701102947. View

13.

Evans I, Llewellyn D, Matthews F, Woods R, Brayne C, Clare L . Living alone and cognitive function in later life. Arch Gerontol Geriatr. 2019; 81:222-233. DOI: 10.1016/j.archger.2018.12.014. View

14.

Haq K, Penning M . Social Determinants of Racial Disparities in Cognitive Functioning in Later Life in Canada. J Aging Health. 2019; 32(7-8):817-829. DOI: 10.1177/0898264319853137. View

15.

Lin F, Wang X, Wu R, Rebok G, Chapman B . Identification of Successful Cognitive Aging in the Alzheimer's Disease Neuroimaging Initiative Study. J Alzheimers Dis. 2017; 59(1):101-111. PMC: 5661994. DOI: 10.3233/JAD-161278. View

16.

Mungas D, Beckett L, Harvey D, Farias S, Reed B, Carmichael O . Heterogeneity of cognitive trajectories in diverse older persons. Psychol Aging. 2010; 25(3):606-19. PMC: 2943999. DOI: 10.1037/a0019502. View

17.

Mayeda E, Glymour M, Quesenberry C, Whitmer R . Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement. 2016; 12(3):216-24. PMC: 4969071. DOI: 10.1016/j.jalz.2015.12.007. View

18.

Majoka M, Schimming C . Effect of Social Determinants of Health on Cognition and Risk of Alzheimer Disease and Related Dementias. Clin Ther. 2021; 43(6):922-929. DOI: 10.1016/j.clinthera.2021.05.005. View

19.

Kornblith E, Bahorik A, Boscardin W, Xia F, Barnes D, Yaffe K . Association of Race and Ethnicity With Incidence of Dementia Among Older Adults. JAMA. 2022; 327(15):1488-1495. PMC: 9020215. DOI: 10.1001/jama.2022.3550. View

20.

Crimmins E, Kim J, Langa K, Weir D . Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. J Gerontol B Psychol Sci Soc Sci. 2011; 66 Suppl 1:i162-71. PMC: 3165454. DOI: 10.1093/geronb/gbr048. View