Racial Disparities in Cognitive Performance in Mid‐ and Late Adulthood: Analyses of Two Cohort Studies

Abstract

Objectives Racial disparities exist for multiple health outcomes and cognitive domains across the lifespan. Many physical health disparities appear less prominent in late life, which is likely due to higher mortality rates for African Americans. This study examined whether this attenuation of racial disparities at older ages observed for physical health outcomes can be extended to cognitive outcomes in mid-life and late-life samples. Evidence of selective survival with respect to cognition would imply that conventional risk factor patterns for dementia may be distorted among older African Americans, and clinical predictions based on less selected white peers will be inaccurate. Design Cross-sectional associations between race and cognitive functioning were examined as a function of age. Setting The National Survey of Midlife Development in the United States (MIDUS) and the Washington Heights-Inwood Columbia Aging Project (WHICAP). Participants 3,857 MIDUS participants (10.5% African American); 2,729 WHICAP participants (53.8% African American). Measurements Composite scores of executive functioning and episodic memory. Results Independent of main effects of age, birth cohort, sex, education and chronic health conditions, significant age by race interactions indicated that racial disparities in episodic memory and executive functioning were larger at younger ages than older ages in both samples. Conclusion Attenuation of racial inequalities at older ages can be extended to cognitive outcomes, which likely reflects selective survival. Research on cognitive disparities or on race-specific causes of cognitive outcomes in old age must incorporate corrections for selective survival if the goal is to identify causal predictors of cognitive outcomes, rather than merely statistical predictors.

Episodic Memory in Later Life: Benefits of Prayer and Meditation

“…This racial imbalance use of meditation means that the users of meditation are likely to have a higher proportion of older adults with lower cognitive function. Such likelihood is indicated by our finding concerning racial differences in episodic memory score, which is in line with previous studies that show lower cognitive function among racial minorities than their White counterparts (Early et al, 2013;Zahodne, Manly, Azar, Brickman, & Glymour, 2016). The existence of racial imbalance could make it difficult for a significant influence of meditation on episodic memory to emerge, as the benefit of meditation has to be considerably high for such significance to be detected.…”

Perspective on the “African American participation in Alzheimer disease research: Effective strategies” workshop, 2018

“…Interestingly, there are age-as-leveler effects in which the surviving members of a disadvantaged group are people with resilient and strong biological, environmental, psychological, or social profiles, such that over time any disparities between the disadvantaged and other groups may get narrower. 18 The three stages of health disparity research are to detect, understand, and then reduce the health disparities. 19 The National Institute on Minority Health Disparities defines a health disparity as "a health difference, on the basis of one or more health outcomes, that adversely affects disadvantaged populations."…”

“…Further study with greater representation is warranted to define the amount of the difference and whether there are factors that make these differences disparities. Interestingly, there are age‐as‐leveler effects in which the surviving members of a disadvantaged group are people with resilient and strong biological, environmental, psychological, or social profiles, such that over time any disparities between the disadvantaged and other groups may get narrower 18 …”

Interactive Effects of Racial Identity and Repetitive Head Impacts on Cognitive Function, Structural MRI-Derived Volumetric Measures, and Cerebrospinal Fluid Tau and Aβ

“…Note that because the term African-American historically refers primarily to individuals descended from enslaved Africans in North America, we will use the term Black as it is inclusive of all individuals who are descended from sub-Saharan Africa regardless of specific ancestry or position within the broader African diaspora. Individuals who identify as Black are at increased risk for cognitive impairment, cognitive decline, and dementia, including Alzheimer's disease (AD) dementia (Potter et al, 2009; Barnes and Bennett, 2014;Gross et al, 2015;Hohman et al, 2016;Zahodne et al, 2016). In vivo MRI studies in older adults show that Black identifying individuals exhibit increased volume of white matter hyperintensities (Brickman et al, 2008) and differences in brain volumes compared to Whites (Sencakova et al, 2001;Brickman et al, 2008;Waldstein et al, 2017;Morris et al, 2019).…”