Premium
P4‐396: Cognitive function in African‐American versus white women of similar educational attainment and healthcare access
Author(s) -
Devore Elizabeth,
Grodstein Fran,
Townsend Mary
Publication year - 2011
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2011.09.210
Subject(s) - cognition , gerontology , verbal fluency test , cognitive decline , cohort , medicine , race (biology) , demography , cognitive test , african american , psychology , health equity , health care , neuropsychology , public health , psychiatry , sociology , political science , disease , law , dementia , gender studies , ethnology , nursing , pathology
Background:Whileworse rates of cognitive declinewith aging in AfricanAmericans than Caucasians have been consistently observed, the explanation for discrepancies is unclear. In most studies, differences in education and healthcare access between races can yield difficulties in differentiating underlying roots of this discrepancy. We report late-breaking results from the Nurses’ Health Study a unique cohort in which all participants have similar education, healthcare access and knowledge regarding the relation of race to cognition in older women. Methods: We assessed baseline cognition among 19,033 white and 247 African-American, registered nurses age 70-81 years, including 6 tests of global cognition, episodic memory, verbal fluency, and working memory. A follow-up assessment was completed 2 years later. Participation and follow-up were > 90% in both races. We used linear regression to estimate mean differences in initial cognition and cognitive decline by race. Results: Healthcare access was very similar across races (eg, recent physical exam was reported by 82% of black and 81% of white women). After adjusting for age and education, AfricanAmericans had significantly worse initial cognition than whites. For example, mean difference in a global composite score (averaging all cognitive tests) in African Americans versus whites was -0.31 standard units (95% CI -0.39, -0.23) for initial cognitive function; this effect estimate was equivalent to the difference in global composite score between women 7 years apart in age that is, the effect of African American race was cognitively equivalent to the effect of 7 years of aging. Similarly, cognitive decline over 2 years was significantly worse by -0.14 units (95% CI -0.22, -0.07). Adjustment for numerous health and lifestyle variables, including vascular factors, depression, BMI, physical activity, father’s occupation in nurses’ childhood, and psychosocial variables (eg, stress at home/ work, caregiving stress, social networks) only somewhat attenuated relations. For example, in the full multivariable model, mean difference in global composite score in blacks versus whites was -0.26 standard units (95% CI -0.34,-0.18). Conclusions: The large disparity in cognitive health across races, even within a cohort of health professionals, underscores this pressing public health issue. Further research is needed to ameliorate cognitive health in older African Americans.