Article

Race and cognitive decline among community-dwelling elders with mild cognitive impairment: Findings from the Memory and Medical Care Study

Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Aging and Mental Health (Impact Factor: 1.75). 10/2011; 16(3):372-7. DOI: 10.1080/13607863.2011.609533
Source: PubMed

ABSTRACT

Previous studies have reported conflicting findings on the relationship between race and cognitive decline in elders with dementia. Few studies have examined the role of race in cognitive decline in mild cognitive impairment (MCI). We investigate the relationship between race and cognitive decline in participants with MCI in a community-based, longitudinal study of cognitively impaired elders.
Based on a validated method utilizing a neuropsychiatric battery, 133 subjects [mean age: 78.7 years (SD = 6.5); female: 112 (76.7%); black: 59 (44.4%)] out of 512 participants in the Memory and Medical Care Study were diagnosed with MCI. The main outcome measure was the Telephone Interview for Cognitive Status (TICS) score over three years. Other baseline subject characteristics (demographics, health-related variables, behavioral, and psychiatric symptoms) were included in the analysis.
Overall, the three-year decline in mean TICS score was significantly higher among African Americans than non-African Americans [3.31 (SD: 7.5) versus 0.96 (SD: 3.0), t-value = 1.96, p-value = 0.05]. General estimating equation analyses revealed that African American race was associated with a faster rate of cognitive decline in all models.
The rate of cognitive decline in MCI appears to be faster in African Americans than non-African Americans in the community. Diagnosis of MCI among African American elders could lead to early interventions to prevent or delay cognitive decline in the future.

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Available from: Betty S Black, Feb 13, 2014
    • "The existing literature varies in regard to the effect of race on cognitive decline. Several studies have found a difference in the rate of cognitive decline by race, with African Americans declining at faster rates than their white counterparts (Lee et al., 2011; Sachs-Ericsson & Blazer, 2005; Yaffe et al., 2009). By contrast, others have found no difference in cognitive decline by race (Atkinson et al., 2005; Masel & Peek, 2009). "
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    ABSTRACT: Objectives.Whether there are racial and ethnic disparities in the rate of cognitive decline among older adults is not clear. The purpose of this study was to determine if there are differences in cognitive decline among racial and ethnic older adults.Method.Data were from the Health and Retirement Study, waves 1998-2010. Participants were community dwelling at baseline (n = 9,492), mostly female participants (58.8%), ranged in age from 65 to 105 years (M = 74.41, SD = 6.97), and had education levels that averaged less than high school (M = 11.7, SD = 3.4). Cognition was examined using a combined score from word recall, Serial 7's, backward counting, and naming tasks. To determine changes in cognition across 12 years, we utilized mixed effects models. Results indicated that after adjusting for covariates, race or ethnicity was unrelated to changes in cognitive performance, but there were significant differences in baseline cognition and these differences were more pronounced after adjusting for age, gender, education, poverty, heart disease, diabetes, high blood pressure.Discussion.It is evident that there are significant differences in baseline cognition, although the rate of cognitive decline across 12 years did not vary significantly by race. These findings support previous assertions that the rate of cognitive decline is not associated with race and suggest that it is likely that baseline cognitive performance is a better indicator of performance over time.
    No preview · Article · Nov 2013 · The Journals of Gerontology Series B Psychological Sciences and Social Sciences
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    • "To better discern the relatively high rates of AD in AAs, a number of studies have compared the prevalence and incidence of AD and related disorders across populations in the US. Whereas a faster rate of cognitive decline in Mild Cognitively Impaired (MCI) AAs than in non-AA was observed in one study that used a community-based sample [11], others found no evidence of racial disparities in cognitive trajectories of MCI [12] [13]. However, in AAs compared to Whites, a significantly slower rate of cognitive decline was reported once AD begins [13] [14]. "
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    ABSTRACT: Prevalence of Alzheimer's disease (AD) will reach epidemic proportions in the United States and worldwide in the coming decades, and with substantially higher rates in African Americans (AAs) than in Whites. Older age, family history, low levels of education, and ɛ4 allele of the apolipoprotein E (APOE) gene are recognized risk factors for the neurodegeneration in AD and related disorders. In AAs, the contributions of APOE gene to AD risk continue to engender a considerable debate. In addition to the established role of cardiovascular disease (CVD) risk in vascular dementia, it is now believed that CVD risk and its endophenotype may directly comediate AD phenotype. Given the pleiotropic effects of APOE on CVD and AD risks, the higher rates of CVD risks in AAs than in Whites, it is likely that CVD risks contribute to the disproportionately higher rates of AD in AAs. Though the advantageous effects of aerobic exercise on cognition is increasingly recognized, this evidence is hardly definitive, and data on AAs is lacking. In this paper, we will discuss the roles of CVD risk factors in the development of AD and related dementias, the susceptibility of these risk factors to physiologic adaptation, and fitness-related improvements in cognitive function. Its relevance to AD prevention in AAs is emphasized.
    Full-text · Article · Apr 2012 · International Journal of Alzheimer's Disease
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    ABSTRACT: We reviewed the use of telephone tests to identify cognitive impairment. We searched PubMed for epidemiological studies and clinical trials reporting the use of telephone tests to identify cognitive impairment. Validation studies and papers published more than 10 years ago were excluded. A total of 132 abstracts were identified, from which 19 epidemiological studies and four clinical trials were selected. Telephone tests were found to reduce selection bias in epidemiology by including people over large areas and facilitating follow-up in longitudinal studies. The most widely used tests were the Telephone Interview for Cognitive Status (TICS) and its modified version, the TICSm. Interviewing a proxy was included in most of the studies to compensate for the unavailability of some participants because of deafness, disease or death. In the epidemiological studies, results of telephone tests were seldom confirmed by a medical examination. Telephone screening for cognitive impairment to identify individuals eligible for clinical trials is impeded by low efficiency and lack of sensitivity for separating early pathological cognitive impairment from dementia and normal ageing.
    No preview · Article · Feb 2013 · Journal of Telemedicine and Telecare
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