Black-white mental status trajectories: What ages do differences emerge?

Abstract

ObjectivesStudies of older U.S. adults have consistently found that African Americans perform worse on cognitive measures than whites, but there are inconsistencies as to whether these findings hold over time. Moreover, studies have focused on adults 51 and older, without considering younger ages; thus it is unclear the age at which these disparities surface. The present study examines black-white disparities in mental status trajectories among adults as young as 25 years over a 25-year period.MethodData come from the Americans’ Changing Lives Study (ACL) (n = 3,617). Participants, ranging from ages 25–100 years old at baseline, were followed from 1986 to 2011 over 5 waves. Mental status was assessed at each wave using a 5-item Short Portable Mental Status Questionnaire. Growth models were used to estimate the associations between age, race, baseline status, and longitudinal changes in mental status, controlling for sociodemographic (e.g., education, income) and other health risk factors (diabetes, stroke, tobacco use, depression).ResultsRacial disparities were seen beginning in midlife and this relationship was curvilinear. Specifically, blacks had a steeper rate of mental status decline than whites and these disparities persisted after accounting for social and health risk factors (b = 0.0090, p < 0.0001).DiscussionStudy findings demonstrate disparities emerge at middles ages and worsen as age increases. This finding highlights the importance of addressing racial disparities in cognition across a larger part of the adult life course. By doing so, we may better be able to capture early-life exposures that influence later-life cognitive outcomes and ultimately lead to disparities.

Greater Disease Burden, Greater Risk? Exploring Cognitive Change and Health Status Among Older Blacks

“…A recent systematic review of dementia incidence and prevalence in the United States indicates a higher risk of cognitive disease among Blacks 65 years and older (Mehta & Yeo, 2017). Studies show that older Blacks perform worse than Whites on specific (e.g., the correct naming of the selected 18 items of the Boston Naming Test) and global tests (e.g., Short Portable Mental Status Questionnaire [SPMSQ]) of cognitive functioning and these differences persist after controlling for demographic and health-related factors (Byrd, Gee, & Tarraf, 2018; Whitfield et al, 2000). These findings have been demonstrated both in baseline or cross-sectional differences (Alley, Suthers, & Crimmins, 2007; Masel & Peek, 2009; Weuve et al, 2018; Whitfield et al, 2000; Wilson et al, 2010; Wolinsky et al, 2011) and in longitudinal outcomes (Byrd et al, 2018; Sawyer, Sachs-Ericsson, Preacher, & Blazer, 2008; Sachs-Ericsson & Blazer, 2005).…”

The Interactive Effects of Education and Social Support on Cognition in African Americans

“…The SPMSQ is a brief assessment of cognitive performance, ranging from intact functioning to severe impairment. Studies have also used this scale as a measure of global cognition, including overall mental status (Byrd et al, 2018; Sachs-Ericsson & Blazer, 2005; Sawyer et al, 2009) and have validated the sensitivity of this instrument for interviewer error when assessing cognitive functioning among older adults (Malhotra et al, 2015). The specific constructs assessed include orientation, knowledge of current and past affairs, memory function related to capacity for self-care, remote memory, and ability to perform several mental operations.…”

“…African American adults are disproportionately affected by morbidity and mortality for multiple age-related cognitive disorders including cognitive impairment (Schwartz et al, 2004; Zhang et al, 2016) and poorer memory. Various studies have suggested that African Americans have a disproportionate burden of early cognitive impairment (Morgan et al, 2008; Roy, 2013; Schwartz et al, 2004; Zhang et al, 2016) as well as greater cognitive decline compared to Whites (Byrd et al, 2018). The elevated risk for age-related cognitive complications in African Americans highlights the importance of considering psychosocial factors that could ameliorate adverse cognitive outcomes within African Americans.…”

Hypertension and cognitive function: a review of life-course factors and disparities

“…The relationship between HTN and cognitive function over the life-course may differ by race and ethnicity [80]. Individuals from five well-characterized prospective cohorts demonstrated a steeper decline in cognition among African Americans compared to their White counterparts, and the difference was eliminated when HTN was accounted for in the multivariate model [81 ▪▪ ].…”