Search

Background: Previous research suggests that hypertension shape cognitive health outcomes in older Blacks (Whitfield 2008). However, few studies have explored the relation between objective and subjective blood pressure (BP) measures and cognitive decline. This study examined whether systolic, diastolic, and self‐reported BP were associated with changes in cognition. Method: Data are drawn from the Baltimore Study of Black Aging—Patterns of Cognitive Aging. At baseline, 602 Black participants (48‐95 years) were enrolled. At follow‐up, approximately 3 years later, 450 participants were re‐interviewed. Cognition included 5 domains: working memory, processing speed, verbal memory, vocabulary, and inductive reasoning. Using an oscillometer automated device (A&D model UA‐ 767), three readings of orthostatic BP were collected and mean systolic (SBP; range = 82‐230.3 mmHg) and diastolic BP (DBP; range = 51‐136.7 mmHg) values were calculated for each participant. BP was treated as a continuous variable. Participants were also asked "Have you ever been told by a doctor or nurse that you have high blood pressure? (yes/no response)" Data were analyzed using multiple linear regression, controlling for sociodemographic and health conditions. Result: Majority of the sample was female (25.4% male) and had at least a high school education (57.1%). Systolic BP was inversely associated with inductive reasoning at follow‐up (b = ‐0.208, p = 0.023; see Table 1), but was not related to any other cognitive domains, after adjusting for age, sex, education, depressive symptoms, comorbidities, diastolic BP, and baseline cognition. Diastolic BP and self‐reported hypertensive status were both unrelated to changes in each of the five cognitive domains (all models, p> 0.05). Conclusion: The present study adds to our understanding of cognitive aging among older Black Americans. Results support previous research, pointing to an independent effect of BP on domain‐specific cognitive changes (Buford 2016), but also extend the literature by highlighting a more pronounced negative effect of systolic BP. These findings suggest that the pathway to cognitive dysfunction is contributed to by BP. Several key mechanisms – including increased risk for stroke and "vascular dementia" (age‐ and hypertension‐related cerebral vasculature changes) – may explain the influence of hypertension on cognitive decline that warrant further study in Black Americans. [ABSTRACT FROM AUTHOR]

Social support (SS) is typically associated with lower emotional distress (e.g., stress and depression) in individuals. However, SS is a multifaceted construct that can vary by quality, quantity (amount), and type (i.e., it can be emotional or instrumental in nature).Objective: The current study examined the relationships between characteristics of SS, stress, and depression in aging African Americans.Participants: Analyses focused on data from 705 participants aged 22-92 years from the Carolina African American Twin Study of Aging.Measurements: Measures included the quality and quantity of emotional and instrumental support received, as well as stress and depression.Design: A series of univariate and increasingly complex multivariate regression models were conducted in MPlus (using the cluster option to control for family structure) to examine the relationships between SS and emotional distress variables.Results: Overall, better quality of emotional SS predicted fewer depression symptoms and less perceived stress, after controlling for age, gender, socioeconomic status variables, and the other subtypes of SS. However, more instances of emotional SS were associated with higher levels of perceived stress, depression symptoms, and more stressful life events within the past year. Likewise, more instrumental SS predicted more perceived stress, while holding the other variables constant.Conclusion: African Americans who experience more emotional distress report more SS, but the quality of emotional support appears to play an important role in the association between reduced levels of stress and depression. These findings suggest that interventions should include approaches to reduce emotional distress as well as enhance the quality SS. [ABSTRACT FROM AUTHOR]

• Cognitive reserve can be built via formal education or other enriching activities. • Proxies of reserve may function differently due to racial health disparities. • For white participants, years of education was the strongest predictor of reserve. • For black participants, education quality and cognitive enrichment predicted reserve. To examine the extent to which three sociobehavioral proxies of cognitive reserve—years of education, education quality, and cognitive enrichment—differ in their prediction of cognitive performance among Black and White people with MS (PwMS). 82 PwMS (Black n = 41, White n = 41) underwent a neurological examination and a neuropsychological evaluation that included tests of word recognition (Wechsler Test of Adult Reading) as well as measures of verbal memory, visuospatial memory, and processing speed (the Brief International Cognitive Assessment for MS; BICAMS). Participants rated their lifetime engagement in various cognitively-enriching activities (Cognitive Reserve Scale). For the full sample, education quality and cognitive enrichment were more strongly associated with cognitive performance than were years of education. Cognitive enrichment was not associated with cognitive performance among participants with high education quality. In contrast, among participants with low education quality, cognitive enrichment was strongly associated with cognitive performance, suggesting that high engagement in cognitively-enriching activities provided similar protection to high education quality. Furthermore, among Black participants, cognitive enrichment and educational quality moderated the relationship between disability level and cognitive performance. In contrast, among White participants, cognitive enrichment did not provide additional protection beyond the buffering effect of education quality. PwMS can successfully build reserve through multiple routes, including formal education or informal cognitive enrichment. Treatment for MS should incorporate cognitively-enriching activities to build resilience against cognitive decline, particularly for members of marginalized racial/ethnic groups, who are at greatest risk for poor health outcomes, and for whom years of education may not best reflect education quality. [ABSTRACT FROM AUTHOR]

Background: Previous research suggests that chronic health conditions and financial hardship robustly shape cognitive health outcomes, including ADRD risk in older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship modifies the impact of self‐reported chronic health conditions on episodic memory among a representative sample of older Blacks enrolled in the 2006 Health and Retirement Study (HRS). Method: The study included 934 older Blacks (50+ years) who completed the psychosocial leave‐behind questionnaire in the 2006 wave of the HRS. Episodic memory included a composite standardized score of immediate and delayed recall. Six chronic health conditions (e.g., hypertension, diabetes, stroke) were summed and dichotomized (0‐1 vs. as ≥2 conditions). Financial hardship was assessed as self‐reported difficulty paying monthly bills (range: not at all=0 to very/completely=3). Weighted OLS regression models tested independent associations between chronic health conditions and episodic memory, controlling for sociodemographic characteristics. An interaction term tested moderation by financial hardship. Result: The majority of the sample was female (39.34% male) and had less than a high school education (35.89%; Table 1). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender, education and income (F 2, 49 = 4.97, p= 0.011; see Table 2 and Figure 1). Conclusion: The present study adds to our understanding of cognitive aging among older Black Americans. Results support previous research, pointing to the independent negative effects of both chronic diseases and subjective financial burden, but also extend the literature by suggesting an interactive effect. Specifically, multimorbidity was more strongly associated with worse episodic memory functioning among older Blacks with less financial hardship, which appeared to be driven by the relatively low cognitive functioning among those with the greatest financial hardship. This pattern of results suggest that financial hardship may be just as consequential for cognitive aging as chronic diseases for older Blacks. [ABSTRACT FROM AUTHOR]

African American women with osteoarthritis (OA) are at high risk of experiencing pain. They report more pain than non-Hispanic White women and men of other racial/ethnic groups. This pain can limit independence and diminish their quality of life. Despite the detrimental effects that pain can have on older African American women with OA, there is a dearth of literature examining factors beyond the OA pathology that are associated with pain outcomes within this population. The purpose of this study was to examine the relationships between racial discrimination and depressive symptoms with pain intensity in African American women with OA. The sample comprised of 120 African American women, aged 50-80 years, with OA, from Texas and New Mexico. The women completed survey booklets to answer study questionnaires. We used multiple linear regression to test associations between racial discrimination, depressive symptoms, and pain intensity. We tested whether depressive symptoms mediated the relationship between racial discrimination and pain intensity by using bootstrapping. Results indicated that racial discrimination was significantly associated with pain intensity and that this relationship was mediated by depressive symptoms, even after controlling for body mass index, years of education, and length of time with OA. Both depressive symptoms and racial discrimination may be modifiable. If these modifiable factors are addressed in this population, there may be decreased pain in middle-aged and older African American women. [ABSTRACT FROM AUTHOR]

Older African Americans consistently report diminished capacities to perform activities of daily living (ADL) compared with other racial groups. The extent to which bodily pain is related to declining abilities to perform ADL/ADL disability in African Americans remains unclear, as does whether this relationship exists to the same degree in African American men and women. For nurses to provide optimal care for older African Americans, a better understanding of the relationship between bodily pain and ADL disability and how it may differ by sex is needed. The aim of this study was to examine whether pain, age, education, income, marital status and/or comorbid conditions were associated with ADL disabilities in older African American women and men. This was a cross-sectional descriptive study. The sample included 598 participants (446 women, 152 men) from the first wave of the Baltimore Study on Black Aging. African American women (odds ratio [OR] = 4.06; 95% confidence interval [CI] 2.63-6.26) and African American men (OR = 6.44; 95% CI = 2.84-14.57) who reported bodily pain had greater ADL disability than those who did not report bodily pain. Having two or more comorbid conditions also was significantly associated with ADL disability in African American women (OR = 3.95; 95% CI: 2.09-7.47). Further work is needed to understand pain differences between older African American women and men to develop interventions that can be tailored to meet the individual pain needs of both groups. [ABSTRACT FROM AUTHOR]

Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization (p < .01), Anxiety (p < .05), Phobic Anxiety (p < .05), and Psychoticism (p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index (p < .05) and the Positive Symptoms Total from the SCL-90-R (p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources. [ABSTRACT FROM AUTHOR]

Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization (p < .01), Anxiety (p < .05), Phobic Anxiety (p < .05), and Psychoticism (p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index (p < .05) and the Positive Symptoms Total from the SCL-90-R (p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is significant attention to the growing elderly African American population and estimating who and how many within this population will be affected by cognitive impairment. Objective: The etiology of cognitive impairment has not been well studied in African Americans and the contribution of genetic and environmental influences to cognitive impairment is not clear. Methods: We calculated concordance rates and heritability for cognitive impairment in 95 same-sexed pairs of African American twins from the Carolina African American Twin Study on Aging (CAATSA). The sample had an average age of 59.6 years (SD = 8.6 years, range 50-88 years) and 60% were female. The Telephone Interview for Cognitive Status (TICS) was used to assess cognitive impairment with a lower cutoff based on our previous research with African Americans. Results: Thirteen of the monozygotic (MZ) twins (30.2%) and 9 of the dizygotic (DZ) twins (17.3%) were cognitively impaired. The concordance rate was 72% for MZ and 45% for DZ. We found the heritability for cognitive impairment to be 54%. Conclusions: The study findings indicate that cognitive impairment is highly heritable, suggesting that genetics may play a relatively large role in the development of cognitive impairment in African American twins. [Copyright &y& Elsevier]

Background: There has been sparse attention paid to the cognition of older men and potential race differences in cognitive ability among older men. Men's health disparities are likely to continue to increase in the next few decades, likely due to an aging baby boom cohort; increases in racial diversity in the US; and increases in life expectancy among both Black and White men. Our objective was to examine the completed cognitive intervention trials to ascertain the proportion of Black men and racial differences in such trials. Method: We conducted a scoping review of reported cognitive intervention trials between the years 2000 and 2020. We searched PubMed, Google Scholar, CINHAL, Cochrane, and Clinicaltrials.gov for cognitive intervention trials using the following MeSH terms – "cognitive intervention", "mild cognitive impairment", "dementia", "Alzheimer's disease", and "cognitive disorder". Inclusion criteria included U.S, based interventions intended to improve cognition. Result: We found 293 unique trials that met our search terms of which 66 were included for final analysis. The rest were excluded due to not being in the US, only including healthy participants, and use of non‐cognitive interventions. We were able to assess the number of Black men in 9 out of the 66 trials, because the trials were either all White (n=8) or all Black (n=1). Of the 9 trials we could assess, 8 had no Black participants (thus no Black men) and the one with all Black participants had 21% men. Of the remaining 57 trials, 32 did not report race and 25 included race and sex data but did not include race‐sex categories and thus we were unable to determine the number of black men included. Conclusion: We were unable to determine if cognitive intervention trials included sufficient proportions of Black men due to non‐reporting of race, race‐sex categories, and lack of inclusion of Black persons in trials. Our results beg the question of how we can understand cognitive health disparities and improve representation in trials if we don't include the information that would allow us to make that determination. [ABSTRACT FROM AUTHOR]

This study examined whether measures of health status enhance the prediction of performance on everyday problem solving in adult African Americans. The sample consisted of 209 community-dwelling African American adults with a mean age of 66.82 years (SD = 7.95). The following variables were included in the analysis: Everyday Problems Test (EPT), summary index of chronic illnesses (cardiovascular disease, hypertension, arthritis, stroke, and diabetes), self-rated health (current health, health in the past month, health compared with others, health compared with 5 years ago), and demographic information. Using hierarchical regression and follow-up communality analysis, the authors found that the number of chronic illnesses and self-rated health as compared with 5 years prior were significant and unique predictors of performance on the EPT but did not account for all of the demographic-related variance. The results indicate that health indices contribute to the variability in everyday cognition in this understudied population. [ABSTRACT FROM AUTHOR]

Presents an overview of behavioral medicine research on sociodemographically diverse populations in the U.S. Implications of social and economic diversity on behavioral medicine research; Elimination of health disparities in racial and ethnic populations; Influence of social and economic classifications on the treatment of disease.