Issues of Diversity in Cognitive Aging

2019 ◽  
pp. 851-864
Author(s):  
Lisa L. Barnes
Keyword(s):  
Cognitive Impairment ◽  
African Americans ◽  
Racial Differences ◽  
Cognitive Aging ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Racial Groups ◽  
Majority Population ◽  
Aging Studies ◽  
Rapid Pace

Cognitive impairment associated with aging and Alzheimer’s disease (AD) is among the most common and debilitating conditions, and it poses a major public health problem. Projections indicate that the prevalence of cognitive impairment is expected to increase substantially in the next decade. This will be particularly true for minority populations, especially the older African American population, which is growing at an even more rapid pace than the older majority population. This chapter presents an overview of studies that have examined racial differences in cognitive aging. Studies have found consistent level differences in cognitive performance, with older African Americans tending to score lower on cognitive tests compared to similarly aged non-Hispanic Whites, even after adjusting for confounding factors such as education and socioeconomic status. Such findings have led to the proposal that African Americans are more likely to have cognitive impairment and are at greater risk of AD. The chapter presents critical challenges in comparing African Americans and Whites on cognitive function tests, and it discusses the utility of using longitudinal designs to compare the racial groups. It also discusses critical barriers to understanding of racial differences in the field and offers concrete actions that should be taken to move the field forward in this area.

Ethnicity and Antipsychotic Response

1997 ◽  
Vol 31 (11) ◽  
pp. 1360-1369 ◽  
Author(s):  
Edyta J Frackiewicz ◽  
John J Sramek ◽  
John M Herrera ◽  
Neil M Kurtz ◽  
Neal R Cutler
Keyword(s):  
African Americans ◽  
Environmental Factors ◽  
Racial Differences ◽  
Future Research ◽  
Racial Groups ◽  
Prescribing Practices ◽  
Data Synthesis ◽  
Medline Search ◽  
Study Selection ◽  
And Control

OBJECTIVE: To review the data generated by studies examining interethnic/racial differences in response to antipsychotics. DATA SOURCES: A MEDLINE search (1966-19%) identified all articles examining differences in antipsychotic response among Caucasians, Asians, Hispanics, and African-Americans, as well as articles evaluating postulated mechanisms for these differences. STUDY SELECTION: All abstracts, studies, and review articles were evaluated. DATA SYNTHESIS: Ethnic/racial differences in response to antipsychotic medications have been reported and may be due to genetics, kinetic variations, dietary or environmental factors, or variations in the prescribing practices of clinicians. Studies suggest that Asians may respond to lower doses of antipsychotics due to pharmacokinetic and pharmacodynamic differences. Research relevant to African-Americans is limited, but some studies suggest that differences in this group may be due to clinician biases and prescribing practices, rather than to pharmacokinetic or pharmacodynamic variability. CONCLUSIONS: Future research directed at validating the hypotheses that different ethnic/racial groups show variations in response to antipsychotics should focus on homogenous ethnic groups, use recent advances in pharmacogenetic testing, and control for such variables as observer bias, gender, disease chronicity, dietary and environmental factors, and exposure to enzyme-inducing and -inhibiting agents. Clinicians should be aware that potential interethnic/racial differences in pharmacodynamics and pharmacokinetics may exist that can alter response to antipsychotics.

Abstract 491: Racial Disparities in the Trends of Acute Myocardial Infarction Outcomes Among Medicaid Patients, 2007-2011

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Oluwole M Adegbala ◽  
Akintunde Akinjero ◽  
Samson Alliu ◽  
Adeyinka C Adejumo ◽  
Emmanuel Akintoye ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
African Americans ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Racial Differences ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Racial Groups

Background: Although, in-hospital mortality from acute myocardial infarction (AMI) have declined in the United States recently, there is a gap in knowledge regarding racial differences in this trend. We sought to evaluate the effect of race on the trends in outcomes after Acute Myocardial Infarction among Medicaid patients in a nationwide cohort from 2007-2011 Methods: We extracted data from the Nationwide Inpatient Sample (NIS) for all hospitalizations between 2007 and 2011 for Medicaid patients aged 45 years or older with principal diagnosis of AMI using ICD-9-CM codes. Primary outcome of this study was all cause in-hospital mortality. We then stratified hospitalizations by racial groups; Whites, African Americans and Hispanics, and assessed the time trends of in-hospital mortality before and after multivariate analysis. Results: The overall mortality from AMI among Medicaid patients declined during the study period (8.80% in 2007 to 7.46% in 2011). In the adjusted models, compared to 2007, in-hospital mortality from AMI for Medicaid patients decreased across the 3 racial groups; Whites (aOR= 0.88, CI=0.70-0.99), African Americans (aOR=0.76, CI=0.57-1.01), Hispanics (aOR=0.87, CI=0.66-1.25). While the length of hospital stay declined significantly among African American and Hispanic with 2 days and 1.76 days decline respectively, the length of stay remained unchanged for Whites. There was non-significant increase in the incidence of stroke across the various racial groups; Whites (aOR= 1.23, CI=0.90 -1.69), African Americans (aOR=1.10, CI=0.73 -1.64), Hispanics (aOR=1.03, CI=0.68-1.55) when compared to 2007. Conclusion: In this study, we found that in-hospital mortality from AMI among Medicaid patients have declined across the racial groups. However, while the length of stay following AMI declined for African Americans and Hispanics with Medicaid insurance, it has remained unchanged for Whites. Future studies are necessary to identify determinants of these significant racial disparities in outcomes for AMI.

Perceived Stress is Associated with Alzheimer’s Disease Cerebrospinal Fluid Biomarkers in African Americans with Mild Cognitive Impairment

2020 ◽  
Vol 77 (2) ◽  
pp. 843-853
Author(s):  
Antoine R. Trammell ◽  
Darius J. McDaniel ◽  
Malik Obideen ◽  
Maureen Okafor ◽  
Tiffany L. Thomas ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
African Americans ◽  
Racial Differences ◽  
Perceived Stress ◽  
Cross Sectional Study ◽  
Cross Sectional

Background: African Americans (AA) have a higher Alzheimer’s disease (AD) prevalence and report more perceived stress than White Americans. The biological basis of the stress-AD link is unclear. This study investigates the connection between stress and AD biomarkers in a biracial cohort. Objective: Establish biomarker evidence for the observed association between stress and AD, especially in AA. Methods: A cross-sectional study (n = 364, 41.8% AA) administering cognitive tests and the perceived stress scale (PSS) questionnaire. A subset (n = 309) provided cerebrospinal fluid for measurement of Aβ42, Tau, Ptau, Tau/Aβ42 (TAR), and Ptau/Aβ42 (PTAR). Multivariate linear regression, including factors that confound racial differences in AD, was performed. Results: Higher PSS scores were associated with higher Ptau (β= 0.43, p = 0.01) and PTAR (β= 0.005, p = 0.03) in AA with impaired cognition (mild cognitive impairment). Conclusion: Higher PSS scores were associated with Tau-related AD biomarker indices in AA/MCI, suggesting a potential biological connection for stress with AD and its racial disparity.

scholarly journals Lipid Metabolism in the Development and Progression of Vascular Cognitive Impairment: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Qi Qin ◽  
Yunsi Yin ◽  
Yi Xing ◽  
Xuan Wang ◽  
Yan Wang ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Lipid Metabolism ◽  
Public Health Problem ◽  
Vascular Cognitive Impairment ◽  
Lipid Biomarkers ◽  
Systemic Review ◽  
Major Public Health Problem ◽  
Clinical Biomarkers ◽  
The Brain ◽  
Potential Biomarkers

Background: Vascular cognitive impairment (VCI) is a major public health problem. The current diagnosis of VCI is made based on the assessment of clinical symptoms and neuropsychological measurements, and is supported by neuroimaging. These methods are both time-consuming and expensive, which leads to needs for alternative biomarkers for VCI. Metabolomics is an emerging and powerful tool to discover of new biomarkers of disease, which can investigate variations in different metabolic processes such as lipid, since the brain is highly enriched in lipids and that lipid changes may lead to pathology in the brain. Vascular cognitive impairment is vulnerable to the disturbance of lipid metabolism. Furthermore, blood samples, which could be identified as reliable clinical biomarkers are relatively convenient to obtain and provide a non-invasive assessment. Therefore, our study aims to understand whether peripheral lipid biomarkers can be used as diagnostic biomarkers and monitor the progression of VCI.Methods: We systematically searched the PubMed, Embase, CNKI, and VIP databases to find VCI and lipid metabolism in reports from inception through February 2021. Studies meeting the following criteria were eligible: (1) original studies in humans; (2) lipid metabolites in blood; (3) reports of VCI.Results: Through our review, nine original articles were eligible. Blood-based metabolites that might be potential biomarkers were identified. Most of them including PC, PE, Cers, and ChEs were significantly lower, while elevation of FAs and DGs were associated with VCI. Most importantly, these blood-based metabolites might be proposed as potential biomarkers for VCI, which provides direction for further validation.Discussion and Conclusion: To the best of our knowledge, this is the first systemic review concerning the relationship of lipid metabolism and VCI. It identifies potential biomarkers and provides insights into the disease pathobiology. However, more advanced studies and researches on a lipidomic platform must be done to understand the exact pathology behind and identify potential lipid biomarkers, which might help achieve the goal of discovering novel therapeutics.

scholarly journals Sickle Cell Trait and Risk of Cognitive Impairment in African Americans: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1322-1322 ◽  
Author(s):  
Christina Cahill ◽  
Marguerite Ryan Irvin ◽  
Neil A Zakai ◽  
Rakhi P. Naik ◽  
Leslie McClure ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
African Americans ◽  
Kidney Disease ◽  
Racial Differences ◽  
Odds Ratio ◽  
Sickle Cell Trait ◽  
Function Testing

Abstract Background:Sickle cell anemia (SCA) has been associated with cognitive dysfunction, perhaps in part due to vascular occlusive disease. Increasing evidence suggests that some complications of SCA might also affect those with sickle cell trait (SCT), including chronic and end-stage kidney disease and venous thromboembolism. Thus, SCT may not be a benign condition. Based on data that SCA may influence cognition, we hypothesized that SCT is a risk factor for cognitive impairment in African-Americans. Methods: Participants were African-American adults aged 45 and older from a national prospective cohort study of 30,239 white and black Americans; the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The study collected extensive baseline risk factor data, and conducted baseline and annual cognitive function testing using the Six-Item Screener (SIS), a validated telephone-administered instrument for global cognitive function that yields a score from 0 to 6. Participants included in this analysis were African-Americans without SCA who had available data on baseline and at least one follow up SIS, SCT genotyping and principal components of ancestry. Participants with baseline SIS ≤4 were excluded as having prevalent impairment. Incident cognitive impairment was defined as having a score at the most recent assessment of ≤4. Logistic regression was used to model associations of SCT with incident cognitive impairment, adjusted for risk factors (listed in table footnote). Results:Among 5,507 participants (mean age 63.5), 731 developed incident cognitive impairment with average follow up of 8.1 years. Those with incident cognitive impairment were more likely to be male with prebaseline history of cardiovascular diseases, diabetes, hypertension and dyslipidemia, and had lower income and education. They were slightly more likely to have SCT (7.9% vs 7.3%). In sequentially adjusted models (table), there was no association of SCT with incident cognitive impairment, with a fully adjusted odds ratio of 1.16 (95% CI 0.79-1.71). There were no significant differences in this odds ratio by age, diabetes, hypertension, dyslipidemia, cardiovascular disease, kidney disease or smoking status (p for interaction with SCT all >0.4). Conclusion:In this prospectively followed general population cohort of middle-aged and older adults with longitudinal cognitive function testing, SCT was not associated with increased risk of incident cognitive impairment overall or in various high-risk subgroups. These findings suggest that unlike in SCA, SCT does not result in chronic cerebrovascular dysfunction. To confirm and extend these findings, further work is needed on associations of SCT with specific domains of cognitive function. Disclosures No relevant conflicts of interest to declare.

scholarly journals Role of Place in Explaining Racial Heterogeneity in Cognitive Outcomes among Older Adults

2015 ◽  
Vol 21 (9) ◽  
pp. 677-687 ◽  
Author(s):  
Sze Yan Liu ◽  
M. Maria Glymour ◽  
Laura B. Zahodne ◽  
Christopher Weiss ◽  
Jennifer J. Manly
Keyword(s):  
Older Adults ◽  
African American ◽  
African Americans ◽  
Racial Disparities ◽  
Racial Differences ◽  
Cognitive Aging ◽  
School Attendance ◽  
Cognitive Outcomes ◽  
Older Americans ◽  
Years Of Schooling

AbstractRacially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9% of the variance in years of schooling, 6% of memory, and 12% of language. Among HRS African Americans, state of school attendance accounted for 13% of the variance in years of schooling and also contributed to variance in cognitive function (7%), memory (2%), and vocabulary (12%). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education. (JINS, 2015, 21, 677–687)

scholarly journals Racial Health Disparities in Coronavirus Deaths

2021 ◽  
Author(s):  
Daniel L. Howard
Keyword(s):  
United States ◽  
African American ◽  
Health Disparities ◽  
African Americans ◽  
Racial Disparities ◽  
Racial Differences ◽  
Causes Of Death ◽  
Current Trend ◽  
Racial Groups ◽  
Racial Health Disparities

Preliminary racial data on the coronavirus pandemic indicates that African Americans are much more likely to experience infections, hospitalizations, and death from the virus in comparison to other racial groups. While this appears to be an alarming health outcome regarding African Americans, it is, in fact, not surprising, nor even new information, considering the historical context of racial health disparities and the marginal health of African Americans in the United States. The leading causes of death for African Americans generally and historically reflects the leading causes of death for the entire United States population. More research, and obviously data, is needed to fully understand the factors that cause the overall racial health disparities, in general, and racial disparities in coronavirus cases and deaths, in particular. In the case of the coronavirus pandemic, the racial disparities in deaths reflect racial differences in the way that African Americans live, work, and exist as a result of their ‘second-class citizenship’ with respect to their lower socioeconomic status in comparison to other racial groups. From a health policy perspective, challenges exist to reversing the current trend in coronavirus deaths among African Americans due to a myriad of historic, consistent, and pervasive societally-induced deficits within African American life. The proposed chapter will rely on systematic review of the extant literature on racial health disparities to identify multiple factors that may affect African American deaths due to the current coronavirus pandemic. The chapter will also rely on this framework to inform evidence-based approaches to improve public health for African Americans.

scholarly journals Linking Sleep and Racial Health Disparities: Characterizing Sleep in the National Sleep Research Resource

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 629-630
Author(s):  
Alycia Sullivan Bisson ◽  
Susan Redline ◽  
Shaun Purcell
Keyword(s):  
Health Disparities ◽  
Racial Differences ◽  
Cognitive Aging ◽  
Linear Models ◽  
Spectral Power ◽  
Cardiometabolic Health ◽  
Racial Groups ◽  
Racial Health Disparities ◽  
Age Related ◽  
Interaction With Age

Abstract To address the problem of racial health disparities, prior work has studied differences in environmentally-influenced and modifiable health behaviors, like nutrition and physical activity. Mounting evidence suggests that sleep plays a key role in health, including cardiometabolic and neurodegenerative disease. Thus, studies have begun to characterize sleep differences across racial groups. We aimed to better quantify differences in objective sleep that may contribute to racial health disparities. In preliminary analyses, we examined whole-night polysomnography from 728 individuals between the ages of 7 and 86 (M: 41.39, SD: 19.39) in the diverse Cleveland Family Study (45% males, 57% African Americans; AAs). Linear models examined racial differences in a battery of sleep metrics and tested interactions with age. Microarchitecture metrics included NREM spindle and slow oscillations, important to cognitive-aging and cardiometabolic health. AAs spent relatively more time in lighter N2 (b= 0.295, p<.001) and less time in deeper N3 (b= -0.364, p<.001) sleep. AAs also had lower NREM spectral power across multiple frequency bands (p<.001), and reductions in spindle characteristics including amplitude (b = -0.537, p<.001) and density (b = -0.341, p<.001). Metrics showed qualitatively different patterns of interaction with age: e.g., racial differences in N3 duration increased with age, and differences in spindle amplitude decreased with age (interactions p<.001), despite marked age-related reductions across all individuals. This work may help to identify specific modifiable aspects of sleep as targets for ameliorating health disparities. Patterns of racial differences over the lifecourse may illuminate different mechanisms being active at different points in development.

scholarly journals Race/Ethnic Issues in Obesity and Obesity-Related Comorbidities

2004 ◽  
Vol 89 (6) ◽  
pp. 2590-2594 ◽  
Author(s):  
Nicole Cossrow ◽  
Bonita Falkner
Keyword(s):  
African Americans ◽  
Racial Differences ◽  
Mexican Americans ◽  
The United States ◽  
Racial Groups ◽  
Lifestyle Behaviors ◽  
Insulin Resistant ◽  
Race Disparity ◽  
Prevalence Of Obesity

Abstract The prevalence of obesity is increasing among all age and racial groups in the United States. There is, however, a disproportionate rise in the prevalence of obesity among African-Americans and Hispanic/Mexican Americans. Obesity is a major contributor to the insulin resistant syndrome (IRS), a condition of multiple metabolic abnormalities that is a precursor to type 2 diabetes, and confers a high risk for cardiovascular events. The estimated prevalence of IRS is also greater in Mexican Americans and African-Americans than in Caucasians. The IRS is identifiable in children, and as with adults, there are racial differences in its expression even at a young age. The obesity-associated diseases, including diabetes and hypertension, are found at higher rates within the minority races compared with Caucasians. However, there are differences, in that obesity-related hypertension occurs at higher rates among African-Americans, and obesity-related diabetes occurs at higher rates among Mexican Americans. Race/ethnic differences in lifestyle behaviors and economic disadvantage may account for some of the race disparity in obesity-related diseases and disease outcomes. Environmental factors, however, do not explain all of the race disparity in disease expression, indicating that there are genetic/molecular factors that are operational as well.

scholarly journals FALLS’ RISK ANALYSIS OF OLDER PATIENTS IN NURSING DEPARTMENTS: ONE MONTH STUDY

2016 ◽  
Vol 4 ◽  
pp. 642-646
Author(s):  
Agnė Jakavonytė-Akstinienė ◽  
Jūratė Macijauskienė
Keyword(s):  
Cognitive Impairment ◽  
Age Groups ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Severe Injuries ◽  
Term Care ◽  
Falls Risk ◽  
The Past ◽  
Significant Difference ◽  
Risk Of Falls

BACKGROUND: Falls are a major public health problem, especially in the elderly. Of people who suffer falls, 20- 30% experience mild to severe injuries. Timely assessment of risk factors can prevent some of these falls occurring.PURPOSE OF STUDY: To assess the falls risks factors of patients in nursing departments.METHODS: The study was conducted January to September, 2015 in a Lithuanian long-term care and treatment hospital. The Morse Fall Scale was used for assessment of falls risk, which were evaluated within 48 hours and then after one month of admission to the hospital.RESULTS: The study involved 177 respondents. After one month of admission to the hospital, 129 participants took part in the survey. During the first stage of the study, the difference in falls between the age groups and falls risk was statistically significant (p = 0.019). In addition, statistically significant differences (p = 0.004 and p = 0.000) were found between the patients’ cognitive impairment, falls within the past 1-year period, and the risk of falls during 48 hours after hospitalization. After one month of admission to the hospital, it was found that differences in falls risk was not statistically significant among age groups (p = 0.360) or the patients’ cognitive impairment (p = 0.200).CONCLUSION: An assessment of patients within 48 hours of hospitalisation revealed a statistically significant difference between the patients having suffered a fall within the past year and the current risk of falls.

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