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O2–13–04: Simultaneous changes in cognition and physical frailty and the association of neuropathology
Author(s) -
Yu Lei,
Buchman Aron,
Boyle Patricia,
Wilson Robert,
Leurgans Sue,
Schneider Julie,
Bennett David
Publication year - 2013
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.2013.04.210
Subject(s) - neuropathology , cognition , gerontology , cognitive decline , psychology , association (psychology) , dementia , medicine , demography , disease , pathology , neuroscience , psychotherapist , sociology
Background: Dementia rates in the United States have been shown to be higher among black than white elders. Whether this increased incidence reflects greater risk factors among black than white elders has not been extensively evaluated. We sought to determine if black-white differences in dementia rates existed among a cohort of community dwelling elders and whether differences observed could be explained by socioeconomic status (SES) indicators (income, financial adequacy, education and literacy) and health-related factors. Methods: We evaluated dementia risk among 3,075 black and white elders (mean age 74.1 years; 41.7% black; 51.5% female) participating in the prospective Health Aging and Body Composition study and who were free from dementia at baseline. Dementia was determined over a 12 year follow-up by prescribed dementia medications, hospital records, and decline in global cognition. To examine the influence of SES and health related factors on dementia rates, we conducted a series of Coxproportional hazard models in which these variables were sequentially added to the base model in covariate blocks. Results: Over follow-up, 575 (18.7%) participants developed dementia. Black participants had a greater risk of developing dementia than white participants (21.9% vs. 16.4%, P<.0001; unadjusted hazard ratio [HR] 1.57; 95% confidence interval [CI], 1.33, 1.84). The HR lessened somewhat after adjustment for demographics, APOE e4, comorbidities, and lifestyle factors (1.40; 95%CI: 1.17, 1.68) but was greatly reduced and no longer statistically significant when SES was added to the model (HR: 1.17, 95% CI: 0.95-1.45). Additional adjustment for baseline 3MS score attenuated the effect size slightly. Conclusions: Results suggest that differences in risk factors, especially SES, may contribute to the higher dementia rates observed among black compared to white elders. Strategies aimed at reducing these disparities may favorably impact dementia incidence.