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Introduction: We investigated cognitive profiles among diverse, middle‐aged and older Hispanic/Latino adults in the Study of Latinos–Investigation of Neurocognitive Aging (SOL‐INCA) cohort using a cross‐sectional observational study design. Methods: Based on weighted descriptive statistics, the average baseline age of the target population was 56.4 years, slightly more than half were women (54.6%), and 38.4% reported less than a high school education. We used latent profile analysis of demographically adjusted z scores on SOL‐INCA neurocognitive tests spanning domains of verbal memory, language, processing speed, and executive function. Results: Statistical fit assessment indices combined with clinical interpretation suggested five profiles: (1) a Higher Global group performing in the average‐to‐high‐average range across all cognitive and instrumental activity of daily living (IADL) tests (13.8%); (2) a Higher Memory group with relatively high performance on memory tests but average performance across all other cognitive/IADL tests (24.6%); (3) a Lower Memory group with relatively low performance on memory tests but average performance across all other cognitive/IADL tests (32.8%); (4) a Lower Executive Function group with relatively low performance on executive function and processing speed tests but average‐to‐low‐average performance across all other cognitive/IADL tests (16.6%); and (5) a Lower Global group performing low‐average‐to‐mildly impaired across all cognitive/IADL tests (12.1%). Discussion: Our results provide evidence of heterogeneity in the cognitive profiles of a representative, community‐dwelling sample of diverse Hispanic/Latino adults. Our analyses yielded cognitive profiles that may assist efforts to better understand the early cognitive changes that may portend Alzheimer's disease and related dementias among diverse Hispanics/Latinos. Highlights: The present study characterized cognitive profiles among diverse middle‐aged and older Hispanic/Latino adults.Latent profile analysis of neurocognitive test scores was the primary analysis conducted.The target population consists of middle‐aged and older Hispanic/Latino adults enrolled in the Hispanic Community Health Study/Study of Latinos and ancillary Study of Latinos ‐ Investigation of Neurocognitive Aging. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Executive functioning and processing speed are crucial elements of neuropsychological assessment. To meet the needs of the Hispanic/Latino population, we aimed to provide normative data for the Digit Symbol Substitution (DSS) test. METHODS: The target population for the Study of Latinos‐Investigation of Neurocognitive Aging included six heritage backgrounds (n = 6177). Average age was 63.4 ± 8.3 years, 54.5% were female, and mean education was 11.0 ± 4.7 years. Participants were administered the DSS as part of a larger battery. Heritage‐adjusted DSS scores, and percentile cut‐points were created using survey‐adjusted regression and quantile regression models. RESULTS: Age, education, sex, heritage, and language preference were associated with DSS scores. DISCUSSION: Significant correlates of DSS performance should be considered when evaluating cognitive performance. Representative DSS norms for Hispanics/Latinos will advance assessment and accuracy of neurocognitive disorder diagnosis in clinical practice. To facilitate interpretation, we provide norms to reduce test biases and developed an online dashboard. Highlights: Normative data for the Digit Symbol Substitution (DSS) for diverse Hispanic/Latino adults: Results from the Study of Latinos‐Investigation of Neurocognitive Aging (SOL‐INCA) This study is the first to develop norms for the DSS test across four regions of the United States.Factors such as age, education, sex, and Hispanic/Latino heritage and language preference are associated with differences in executive functioning and information processing speed.We created norms and an online dashboard (https://solincalab.shinyapps.io/dsst%5fshiny/) providing an easily accessible tool to evaluate processing speed and executive functioning in Hispanic/Latino adults. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Reproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women. METHODS: Participants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos‐Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7‐year change, and mild cognitive impairment [MCI] prevalence). RESULTS: Younger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence. DISCUSSION: Several aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Few studies have examined the associations of psychosocial factors with cognitive change in Hispanics/Latinos. METHODS: Data from the Hispanic Community Health Study/Study of Latinos‐Investigation of Neurocognitive Aging (HCHS/SOL INCA) and Sociocultural studies were used (n = 2,155; ages ≥45 years). Psychosocial exposures included intrapersonal (ethnic identity, optimism, purpose in life), interpersonal (family cohesion, familism, social networks, social support), and social factors (ethnic discrimination, loneliness, subjective social status). Survey‐linear regression models examined associations between psychosocial exposures and 7‐year cognitive change (global cognition [GC], verbal learning, memory, word fluency [WF], and digit symbol substitution [DSS]). RESULTS: Familism predicted decline in GC, verbal learning, and memory; family cohesion predicted DSS decline; and loneliness predicted memory decline. Ethnic identity was protective against decline in GC and memory, optimism and social support were protective against decline in memory, and purpose in life was protective against WF decline. DISCUSSION: Psychosocial factors are differentially related to cognitive changes. Culturally relevant factors should be explored in Hispanic/Latino cognitive aging research. Highlights: Psychosocial factors are differentially related to cognitive changes in Latinos.Role of culturally relevant factors on cognition should be further explored.Familism predicted decline in global cognition, verbal learning, and memory.Ethnic identity predicted increase in global cognition and memory. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Sleep duration has been associated with dementia and stroke. Few studies have evaluated sleep pattern–related outcomes of brain disease in diverse Hispanics/Latinos. METHODS: The SOL‐INCA (Study of Latinos‐Investigation of Neurocognitive Aging) magnetic resonance imaging (MRI) study recruited diverse Hispanics/Latinos (35–85 years) who underwent neuroimaging. The main exposure was self‐reported sleep duration. Our main outcomes were total and regional brain volumes. RESULTS: The final analytic sample included n = 2334 participants. Increased sleep was associated with smaller brain volume (βtotal_brain = −0.05, p < 0.01) and consistently so in the 50+ subpopulation even after adjusting for mild cognitive impairment status. Sleeping >9 hours was associated with smaller gray (βcombined_gray = −0.17, p < 0.05) and occipital matter volumes (βoccipital_gray = −0.18, p < 0.05). DISCUSSION: We found that longer sleep duration was associated with lower total brain and gray matter volume among diverse Hispanics/Latinos across sex and background. These results reinforce the importance of sleep on brain aging in this understudied population. Highlights: Longer sleep was linked to smaller total brain and gray matter volumes.Longer sleep duration was linked to larger white matter hyperintensities (WMHs) and smaller hippocampal volume in an obstructive sleep apnea (OSA) risk group.These associations were consistent across sex and Hispanic/Latino heritage groups. [ABSTRACT FROM AUTHOR]

Purpose: In the United States, Hispanic‐Latino children reach puberty earlier on average than non‐Hispanic white children. Yet among U.S. Hispanic/Latino children, pubertal timing comparisons between immigrant generations have not been made, hence we examined whether pubertal timing differs by immigrant generational status, independent of BMI and acculturation measures. Methods: Cross‐sectional data on 724 boys and 735 girls, aged 10–15 years, from the Hispanic Community Children's Health Study/Study of Latino (SOL) Youth, were used to predict the median ages of thelarche, pubarche, and menarche in girls, and pubarche and voice change in boys, using Weibull survival models, while adjusting for SOL center, BMI, and acculturation. Results: In girls, the first generation began thelarche earlier than second and third generations (median age [years] [95% confidence interval]: 7.4 [6.1, 8.8] vs. 8.5 [7.3, 9.7] and 9.1 [7.6, 10.7], respectively), but began menarche later (12.9 [12.0,137] vs. 11.8 [11.0, 12.5] and 11.6 [10.6, 12.6], respectively). Pubertal timing and tempo for boys did not differ by generational status. Conclusions: First‐generation U.S. Hispanic/Latino girls had the earliest thelarche, latest menarche and longest pubertal tempo, compared to second and third generations. Factors beyond BMI and acculturation may account for the differences in pubertal timing by generational status of U.S. Hispanic/Latino girls. [ABSTRACT FROM AUTHOR]

Aim: To examine whether baseline periodontal disease is independently associated with incident prediabetes and incident diabetes in Hispanics/Latinos in the United States. Materials and Methods: This study examined 7827 individuals, 18–74 years of age without diabetes, from the Hispanic Community Health Study/Study of Latinos. Participants received a full‐mouth periodontal examination at baseline (2008–2011), and the disease was classified using the Centers for Disease Control and Prevention/American Academy of Periodontology case definitions. At Visit 2 (2014–2017), incident prediabetes and diabetes were assessed using multiple standard procedures including blood tests. Multivariable survey Poisson regressions estimated the rate ratio (RR) and 95% confidence intervals (CIs) of incident prediabetes and incident diabetes associated with periodontal disease severity. Results: Among the individuals without prediabetes or diabetes at baseline, 38.8% (n = 1553) had developed prediabetes and 2.2% (n = 87) had developed diabetes after 6 years. Nineteen percent (n = 727) of individuals with prediabetes at baseline developed diabetes after 6 years. Adjusting for all potential confounders, no significant association was found between periodontal disease severity and either incident prediabetes (RR: 0.93; 95% CI: 0.82–1.06) or incident diabetes (RR: 0.99; 95% CI: 0.80–1.22). Conclusions: Our findings suggest that among a diverse cohort of Hispanic/Latino individuals living in the United States, there was no association between periodontal disease severity and the development of either prediabetes or diabetes during a 6‐year follow‐up period. [ABSTRACT FROM AUTHOR]

Introduction: Despite increased risk of cognitive decline in Hispanics/Latinos, research on early risk markers of Alzheimer’s disease in this group is lacking. Subjective cognitive decline (SCD) may be an early risk marker of pathological aging. We investigated associations of SCD with objective cognition among a diverse sample of Hispanics/Latinos living in the United States. Methods: SCD was measured with the Everyday Cognition Short Form (ECog-12) and cognitive performance with a standardized battery in 6125 adults aged ≥ 50 years without mild cognitive impairment or dementia (x̄ age = 63.2 years, 54.5% women). Regression models interrogated associations of SCD with objective global, memory, and executive function scores. Results: Higher SCD was associated with lower objective global (B = −0.16, SE = 0.01), memory (B = −0.13, SE = 0.02), and executive (B = −0.13, SE = 0.02, p’s < .001) function composite scores in fully adjusted models. Discussion: Self-reported SCD, using the ECog-12, may be an indicator of concurrent objective cognition in diverse middle-aged and older community-dwelling Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Background: We developed a statistical region of interest (sROI) of gray matter (GM) for which cortical thickness (CT) significantly differed in a "training set" of 100 cognitively normal and 100 individuals with incident dementia in the Framingham Heart Study. sROI significantly predicts incident cognitive impairment and dementia in both FHS and the highly diverse UC Davis Alzheimer's disease longitudinal cohort. Here we describe a similar analysis of participants of Study of Latinos‐Investigation of Neurocognitive Aging‐MRI (SOL‐INCA‐MRI). Methods: Hispanics/Latinos (n=6,377 ages 50‐86) were enrolled in the Study of Latinos ‐ Investigation of Neurocognitive Aging (SOL‐INCA) of which 1,143 also participated in SOL‐INCA‐MRI ancillary study. Cognitive impairment (CI) was defined as any cognitive domain score falling below (<‐1.0 SD) the SOL‐INCA robust internal normative mean and significant cognitive decline (‐0.055 SD/yr), self‐reported cognitive decline and no or minimal functional impairment over 7 years. Participants with dementia were excluded. MRI CT was computed by the DiReCT method. sROI was derived from statistically significant (via 1,000 non‐parametric permutations) clusters of GM voxels having CT group difference t > 2 over the training set (Fig. 1). Extents of sROI overlap with standard atlas GM regions appear in Table 3. Group differences in variables were assessed by t‐test. Logistic regression assessed the impact on cognitive status of MRI factors: total brain, hippocampal, white matter hyperintensities (WMH), sROI volumes and infarction occurrence, controlling for age, sex, education, and background. Results: The cohort was 64.4 + 7 years of age, 69% female. Nearly 60% with high school or less education, and 21% CI. Table 1 summarizes demographic and MRI measures for CI and cognitively normal (CN). CI individuals were older, had less education, smaller brains, and greater amounts of WMH. Table 2 summarizes results of logistic regression. Education and sROI mean CT were the only significant predictors of cognitive status. Conclusion: Cortical thickness within the sROI was strongly associated with cognitive status, even when other commonly used MRI measures were not. sROI may therefore be a sensitive indicator of incipient CI within SOL‐INCA‐MRI where more traditional measures of Alzheimer's pathology and vascular disease appear insensitive. [ABSTRACT FROM AUTHOR]

Background: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a representative, community‐based study of Hispanics and Latinos across the US that seeks to understand health disparities within this heterogeneous population. The Study of Latinos ‐ Investigation of Neurocognitive Aging MRI (SOL‐INCA MRI) is an ancillary MRI study to HCHS/SOL focused on the genetic influence and cognitive impact of age‐ and disease‐related brain measures. Brain structure undergoes substantial development and remodeling from birth through adulthood. Intracranial volume is a measure of maximum brain development, which is under substantial genetic and environmental influences, and is an independent marker of cognitive resilience. We report the influence of self‐described background on intracranial volume, brain tissue and cortical thickness measures for 1388 individuals studied to date. Method: Hispanics and Latinos (ages 35.9‐85.2 years; 66% female) underwent MRI and analysis at the Imaging of Dementia and Aging (IDeA) laboratory using previously published methods. MRI outcomes of interest included supratentorial intracranial volume (TCV), image segmentation into white matter, gray matter, total brain, and regional cortical thickness. Background was categorized as Cuban, Central American, Dominican, Mexican, Puerto Rican and South American. We performed association analysis using linear regression models accounting for sex, height, background, and their interactions. Result: Height was positively associated with TCV. Women had significantly smaller TCV than men (Table 1). TCV did not vary significantly with age. After adjusting for age, gender, height, and interactions, TCV measures varied significantly by background, and were greatest for Dominicans. Cuban’s and Mexican’s TCV measures were significantly smaller than Dominican’s (Figure 1). Cerebral gray matter volume as a residual of TCV was also significantly greater for Dominicans as compared to all other backgrounds (Table 2). Residuals of brain, gray and white matter varied significantly across backgrounds (Figure 2). Finally, cortical thickness measures varied significantly by background and brain region, being greatest for both Dominicans and Puerto Ricans (Figure 3). Conclusion: Brain development results from multiple factors including gene, environment, and gene‐environment interactions. Investigating the genetic and environmental causes of the heterogeneity of brain measures in SOL‐INCA‐MRI are likely to lead to discoveries related to both brain development and possibly brain aging. [ABSTRACT FROM AUTHOR]

Background and Purpose: There is limited literature on the prevalence of incidental brain MRI findings in the Hispanic/Latino population, despite their increased prevalence of vascular disease and undertreatment of chronic conditions. The purpose of our study was to determine the prevalence of clinically relevant incidental findings on brain MRI examinations obtained as a part of the Study of Latinos–Investigation of NeuroCognitive Aging MRI (SOL‐INCA‐MRI) study. Methods: Brain MRI examinations were obtained on 1389 participants in the SOL‐INCA‐MRI study, a cross‐sectional ancillary study of the Hispanic Community Health Study, Study of Latinos, which is a longitudinal, community‐based study. Study design of SOL‐INCA‐MRI involves imaging cognitively normal and participants with mild cognitive impairment. Brain MRI findings were categorized as Level 1 (normal), Level 1.5 (findings of unclear medical significance), Level 2 (potential medical concern), or Level 3 (medically urgent). This article focuses on Level 2 and Level 3 findings. Results: The average age of the sample was 60.8 years (+/– 10.3 years), 66.1% were females. Level 2 and 3 findings were identified in 117 participants, (8.4%), of which 109 (7.8%) were recommended for medical follow‐up (Level 2), and 8 (0.6%) were recommended for immediate medical attention (Level 3). Brain MRI findings consisted of chronic infarction in 33 (2.4%), vascular abnormality in 27 (1.9%), intracranial mass in 20 (1.4%), other intracranial findings in 28 (2.0%), and skull base/extracranial findings in 26 (1.9%) patients. Conclusion: Incidental findings of clinical relevance were common among SOL‐INCA‐MRI participants, but rarely required urgent medical intervention. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of social support with dental caries experience in Hispanics/Latinos living in the United States (US) and to assess whether the relationship is modified by nativity status. Methods: This cross‐sectional study analysed data for 4459 dentate men and women aged 18‐74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. At baseline (2008‐2011), dentists quantified dental caries experience as the number of decayed, missing, and filled permanent tooth surfaces (DMFS) for all teeth excluding third molars. Social support was assessed according to measures of structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). Covariate‐adjusted multiple linear regression estimated the relationship between social support and dental caries experience and tested whether the association was modified by nativity status (born within the 50 US states, foreign‐born <10 years in the United States, foreign‐born >10 years or more in the United States). Results: In covariate‐adjusted models, each additional role in the social network was associated with 1.39 fewer DMF tooth surfaces (95% CI: −2.21, −0.58) among foreign‐born Hispanics/Latinos with fewer than 10 years lived in the US. For foreign‐born Hispanics/Latinos with 10 years or more in the United States, each additional social network role was associated with 0.57 fewer DMF tooth surfaces (95% CI: −1.19, 0.04). No association was observed between functional social support and dental caries experience regardless of nativity status. Conclusions: Our findings suggest that structural social support is protective against dental caries experience among recent immigrants of Hispanic/Latino background. This association may reflect the importance of social support to integration into the medical and dental infrastructure and thus receipt of dental care. Future research that examines the behavioural and cultural factors that moderate the relationship between social support and dental caries experience will inform development of culturally sensitive dental caries prevention programs for Hispanics/Latinos in the United States. [ABSTRACT FROM AUTHOR]

Background: Childhood is a period of brain plasticity when environmental influences may have long‐lasting effects. Early socio‐economic position (SEP) may influence brain development at vulnerable stages and set the stage for increased vulnerability to Alzheimer's Disease and related dementias (ADRD). In this study, we evaluated whether childhood SEP was related to brain structure in adulthood. Methods: This analysis included the first 1320 individuals (61% women, age range 50‐85) of diverse Hispanic/Latino background with brain magnetic resonance imaging (MRI) assessments from the HCHS/SOL INCA‐MRI study, conducted at four major urban areas (Bronx, NY; Chicago, IL; Miami, FL, and San Diego, CA). Childhood SEP was assessed by self‐reported maternal educational achievement. We also calculated the difference between attained height and genetically predicted height using height‐associated SNPs, sex, and genetic ancestry as a biomarker of early environmental exposures. Positive values indicate taller attained stature than the expected based on SNPs, suggesting favorable early environmental influence on height; negative values suggest environmental conditions limiting growth. Measures of brain structure [total intracranial volume (TICV), total gray matter volume (TGMV) and hippocampus volume (HV)] were obtained using MRI with standardized procedures. Survey linear regression models were conducted adjusting for potential confounders. Results: Low parental educational achievement was common, 55% of mothers completed less than a middle school education. In multivariable linear regression models, higher maternal educational achievement was associated with some measures of brain structure, such as greater TICV (b = 18.6, p<.001 for high school (HS) graduate; b = 26.2, p<.01 for > HS; reference <6 grade), higher TGMV (b = 5.8, p<.02 for HS graduate; b = 5.4, p<.10 for > HS), and higher HV (b = 0.14, p<.01 for HS graduate; b = 0.03, p = NS for greater than HS). Early life factors affecting height were associated with lower TICV (b = ‐18.9, p<.001), lower TGMV (b = ‐6.4, p<.001), and lower HV (b = ‐0.6, p<.01). Conclusion: This study showed associations of early childhood socio‐economic position with brain structure assessed in later adulthood. Findings suggest that height residual is a useful predictor of early life environment affecting later life brain volumes. [ABSTRACT FROM AUTHOR]

Background: The Hispanic/Latino population experiences extensive socioeconomic adversity across the lifespan and is at greater risk of cognitive decline. Yet little is known about the role of life‐course socioeconomic position (SEP) and cognitive function in this population. We assessed the association between childhood SEP and cognitive function in Hispanic/Latino adults, whether this association is mediated by midlife SEP, and whether socioeconomic mobility is associated with cognitive function. Method: We used baseline data (2008‐2011) from 9556 adults aged 45‐74 years of the Hispanic Community Health Study/Study of Latino (HCHS/SOL), a multi‐center cohort study conducted in four major U.S cities. We determined childhood SEP using parental educational attainment. Midlife SEP was determined through an index combining participants' education and household income. We classified participants into socioeconomic mobility categories from childhood to adulthood (e.g., persisting low, upward mobility). Cognitive function was ascertained using neurocognitive tests, including the Six‐Item Screener; Brief‐Spanish English Verbal Learning Test Sum and Recall, Controlled Oral Word Association (or Word Frequency), and the Digit Symbol Substitution Test. Using confirmatory factor analysis and these tests we created a global cognition score. We also standardized z‐score of these neurocognitive measures. Survey linear regression models were performed adjusting for age, sex, Hispanic background, U.S born, smoking, depression, and cardiovascular factors. We also conducted mediation analysis to decompose the direct effect of childhood SEP on cognition and the indirect effect through midlife SEP. Result: Childhood SEP showed a graded association with cognitive function in adulthood with a dose‐response relationship across levels of parental education (β and [95% Confidence Interval (CI)]): Elementary/middle school vs. No schooling 0.34 [0.25‐0.43]; High school (HS) vs. No schooling: 0.53 [0.42‐0.64]; and >HS vs. No schooling: 0.68 [0.57‐0.79]). High midlife SEP was also associated with greater cognitive function relative to low midlife SEP. 37% (95% CI 32%‐44%) of the association between childhood SEP and cognition was mediated through midlife SEP. Holding a high SEP over the life‐course was associated with greater cognitive performance (β: 0.90, 95% CI: 0.79‐1.00) as compared with a persisting low SEP. Conclusion: This study provides evidence that childhood and life‐course SEP influence cognitive performance in adulthood [ABSTRACT FROM AUTHOR]

Background: Everyday modifiable lifestyle factors play a crucial role in the development and maintenance of successful cognitive and neurodegenerative trajectories in later life. Although research has focused on independent associations of physical exercise (PE), diet, body mass index (BMI), and sleep, how all four factors simultaneously work in a larger multimodal association has not been studied. We examine the synergistic associations of all four risk factors to predict two markers of future white matter injury (cerebral free water [FW] content, a sensitive and early biomarker of white matter injury and white matter hyperintensities [WMH]) in Hispanic/Latino‐population. Method: We used cognitively normal older adults (n = 1386; mean age = 50.96(10.14) years; 66.2% female) with cross‐sectional data from the Study of Latinos‐Investigation of Neurocognitive Aging‐Magnetic Resonance Imaging (SOL‐INCA‐MRI). First, we applied path analyses to test independent associations of diet(Healthy‐Eating‐Index‐2010), PE(total activity), BMI, and sleep‐duration (measured 2008‐2015) on FW and WMH (measured 2018‐2022). Higher PE score represents lower exercise. Second, we tested mediations using significant independent predictors of FW and WMH. Third, we explored the best possible models that incorporated all six factors. We accounted for age, sex, and education in the final model. Result: First, lower PE predicted greater WMH (β = 0.171,SE = 0.064,p = 0.008) and FW (β = 0.004,SE = 0.002, p = 0.013). Higher BMI (β = 0.018,SE = 0.007, p = 0.017), and higher FW (β = 22.230,SE = 0.939, p<0.001) was associated with greater WMH. Second, we did not find that any of the three modifiable factors mediated the relationship between PE and FW. However, the association between PE and WMH was mediated by BMI (indirect model[borderline]:β = 0.012,SE = 0.006, p = 0.050) and by FW (indirect model:β = 0.066,SE = 0.025, p = 0.007). Third, the addition of diet and sleep in this double mediation model strengthened both mediations (PE→BMI→WMH:β = 0.012,SE = 0.006, p = 0.039; PE→FW→WMH:β = 0.065,SE = 0.025, p = 0.008) resulting in an overall indirect model (PE→BMI→WMH+ PE→FW→WMH:β = 0.077,SE = 0.025,p = 0.002) (Figure 1). Better diet was associated with lower BMI (β = ‐0.026,SE = 0.012,p = 0.029) and lower PE with more sleep (β = 0.190,SE = 0.061,p = 0.002). Conclusion: We observed that the association between PE and WMH is mediated by both BMI and FW, and the overall double mediation is clearer when diet and sleep are accounted for in the model. Our complex multimodal model provides a potential framework on how everyday modifiable risk factors synergistically predict WMH years later. [ABSTRACT FROM AUTHOR]

Background: Hispanics/Latinos are the largest and most diverse ethnoracial group at high risk for Alzheimer's disease and related dementias across the US. However, this population is largely understudied. We present preliminary findings on the association between cognitive profiles and brain morphometry measures in a large Hispanic/Latino cohort of older adults. Method: We used a longitudinal cohort of cognitively normal older adults (n = 2028; mean baseline age = 54.19 (6.75) years, 69.5% female) from the Study of Latinos‐Investigation of Neurocognitive Aging‐Magnetic Resonance Imaging (SOL‐INCA‐MRI). First, to establish a latent memory variable, we examined confirmatory factor analysis to test loadings of four manifest variables (Spanish‐English‐Verbal‐Learning Test learning and recall, digit symbol, word frequency) at the first (2008‐2015) and second (2015‐2021) cognitive visits. Second, we examined whether tertiles of our latent cognitive score were associated with two measures of brain integrity (white matter hyperintensities [WMH] and hippocampus) measured between 2018‐2022. The brain morphometry measures were regressed independently on cognitive tertiles at both visits. Age at each visit, sex, education, Hispanic/Latino background, and cognitive‐MRI lag time were included as covariates. Result: First, a two‐factor latent memory profile (episodic memory and working memory) best represented our four manifest variables at both visits 1 and 2. Each tertile corresponded to low (1), intermediate (2), and high (3) performing groups. Second, increase in cognitive tertile (from low to intermediate to high) on episodic memory (β = ‐0.157, SE = 0.040, p< 0.001) and working memory (β = ‐0.192, SE = 0.043, p< 0.001) at visit 1 was associated with lower WMH. Increase in cognitive tertile on episodic and working memory at visit 2 was associated with lower WMH (β = ‐0.241, SE = 0.036, p< 0.001 and β = ‐0.260, SE = 0.043, p< 0.001, respectively) and greater hippocampus (β = 0.051, SE = 0.015, p = 0.001 and β = 0.040, SE = 0.018, p = 0.025, respectively). Conclusion: Our preliminary findings showed that cognitive profiles and key brain integrity measures are associated years later in Hispanic/Latino adults. Careful monitoring of cognitive aging profiles in the Hispanic/Latino community may lead to early detection and intervention of older adults at high risk for future neurodegeneration. [ABSTRACT FROM AUTHOR]

Introduction: Non‐alcoholic fatty liver disease (NAFLD) has been associated with increased risk of incident diabetes. But such evidence is lacking in the Hispanic/Latino population, which has high prevalence of obesity and NAFLD. Methods: We conducted a prospective cohort study of 6,928 adults of Hispanic/Latino background who had no diabetes, did not report excessive alcohol use, and no hepatitis B and C infection at baseline (2008–2011). We estimated risk ratios (RR) for incident diabetes, identified from visit 2 examination by glucose measurements or antidiabetic medication use, with baseline liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma‐glutamyl transpeptidase (GGT)). Results: A total of 738 adults developed diabetes during 6 years of follow‐up. After adjusting for participant characteristics at baseline, versus the lowest quartile, highest quartiles of ALT and GGT were associated with risks for incident diabetes (RR for ALT: 1.51 [95% CI 1.03–2.22], p‐trend = 0.006; RR for GGT: 2.39 [1.60–3.55], p‐trend = 0.001). Higher GGT levels predicted increased risk of incident diabetes even among those with ALT or AST below the median levels. The associations of ALT and GGT with incident diabetes were similar among most Hispanic background but were not seen among Dominicans (p for interaction <0.05). The association of AST with incident diabetes was found only among light‐to‐moderate alcohol drinkers (RR = 1.50 [1.20–1.86]) but not abstainers (RR = 0.91 [0.69–1.20], p for interaction = 0.006). Conclusion: Higher ALT and GGT levels are associated with increased risk of developing diabetes among Latinos. Liver enzyme tests might aid in diabetes prevention by identifying high‐risk individuals. [ABSTRACT FROM AUTHOR]

Introduction: Apolipoprotein E (APOE) alleles are associated with cognitive decline, mild cognitive impairment (MCI), and Alzheimer's disease in Whites, but have weaker and inconsistent effects reported in Latinos. We hypothesized that this heterogeneity is due to ancestry‐specific genetic effects. Methods: We investigated the associations of the APOE alleles with significant cognitive decline and MCI in 4183 Latinos, stratified by six Latino backgrounds, and explored whether the proportion of continental genetic ancestry (European, African, and Amerindian) modifies these associations. Results: APOE ε4 was associated with an increased risk of significant cognitive decline (odds ratio [OR] = 1.15, P‐value = 0.03), with the strongest association in Cubans (OR = 1.46, P‐value = 0.007). APOE‐ε2 was associated with decreased risk of MCI (OR = 0.37, P‐value = 0.04) in Puerto Ricans. Amerindian genetic ancestry was found to protect from the risk conferred by APOE ε4 on significant cognitive decline. Discussion: Results suggest that APOE alleles' effects on cognitive outcomes differ across six Latino backgrounds and are modified by continental genetic ancestry. [ABSTRACT FROM AUTHOR]

Background & Aims: Sedentariness and physical inactiveness are associated with deleterious health outcomes, but their associations with liver enzyme elevations remain uncertain. Methods: In 10 385 US Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos, we examined associations of sedentary time and moderate‐to‐vigorous physical activity (MVPA) measured by accelerometers with liver enzyme elevations. Elevated alanine aminotransferase (ALT), aspartate aminotransferase and γ‐glutamyltransferase (GGT) were defined as the highest gender‐specific deciles. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using weighted Poisson regressions. Results: After adjusting for demographical/socioeconomic factors and MVPA, increasing quartiles of sedentary time were associated with a higher prevalence of elevated ALT (PRs [95% CI] = 1.0, 1.17 [0.92‐1.47], 1.21 [0.96, 1.53] and 1.51 [1.13‐2.02]; P‐trend =.007) and elevated GGT (PRs [95% CI] = 1.0, 1.06 [0.82‐1.36], 1.35 [1.06‐1.73] and 1.66 [1.27‐2.16]; P‐trend =.0001). These associations were attenuated but remained significant after further adjustment for cardiometabolic traits including body‐mass index, waist‐hip‐ratio, lipids and homeostatic model assessment of insulin resistance. In contrast, increasing quartiles of MVPA were associated with a lower prevalence of elevated ALT (PRs [95% CI] =1.0, 0.97 [0.77‐1.23], 0.84 [0.66‐1.06] and 0.72 [0.54‐0.96]; P‐trend =.01) after adjusting for demographical/socioeconomic factors and sedentary time, but this association became non‐significant after further adjustment for cardiometabolic traits. Notably, the association of sedentary time with GGT elevation was significant both in individuals meeting the US Physical Activity Guidelines for Americans (MVPA ≥150 minutes/week) and in those who did not (both P‐trend ≤.003). Conclusions: Our findings suggest that objectively measured sedentary time is independently associated with elevated ALT and GGT in US Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Aims: To examine the association of social capital with periodontal disease severity. Materials and Methods: We analysed data obtained from 3,994 men and women aged 18–74 years in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (HCHS/SOL SCAS). From 2008 to 2011, dentists assessed periodontitis status with a full‐mouth periodontal examination. Periodontitis was classified using standardized case definitions. Multivariable logistic regression estimated odds of moderate–severe periodontitis associated with two measures of social capital: structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). Results: For US‐born participants, for each additional person in their social network, the adjusted odds of moderate–severe periodontitis was reduced 17% (OR = 0.83, 95% CI = 0.71, 0.96). However, no association was found between functional support and periodontal disease severity. Conclusions: Greater structural social support was associated with a lower prevalence of moderate–severe periodontitis in US‐born Hispanics/Latinos. These findings suggest that US‐born Hispanics/Latinos with less social support represent a vulnerable segment of the population at high‐risk group for periodontal disease. [ABSTRACT FROM AUTHOR]

Introduction: Non‐alcoholic fatty liver disease (NAFLD) disproportionately affects Hispanic/Latinos and rates of NAFLD vary among Hispanics from different background groups. Genetic variants and continental ancestry contribute to NAFLD disparities among Hispanics. We evaluated two newly identified NAFLD‐associated single nucleotide polymorphisms of HSD17B13, rs72613567:TA and rs62305723:A in Hispanics/Latinos. Methods: Clinical data, genotypes of variants of interest and estimates of continental ancestry were extracted from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) database, which includes a cohort of 16 415 US Hispanic/Latinos. Surrogate endpoints for NAFLD were suspected NAFLD based on unexplained aminotransferase elevation, continuous ALT levels and FIB‐4 scores to estimate hepatic fibrosis. Results: In all, 9342 participants were included for analysis. The rs72613567:TA allele was found in 15.3% and the rs62305723:A allele was identified in 4.5% of HCHS/SOL participants. rs72613567:TA was less frequent in persons with vs without suspected NAFLD (12.4% vs 15.7%, P <.001) and rs72613567:TA was associated with lower FIB‐4 scores (P =.01). For persons with the NAFLD‐associated PNPLA3 rs738409:G allele, the presence of rs72613567:TA was associated with a lower rate of suspected NAFD (odds ratio = 0.76, P <.001). rs72613567:TA was less frequent in Hispanic/Latino background groups with higher rates of suspected NAFLD. The rs62305723:A allele was not associated with suspected NAFLD or FIB‐4 score. Conclusion: The rs72613567:TA allele is associated with lower rates of suspected NAFLD and lower FIB‐4 scores among Hispanic/Latinos and with lower rates of suspected NAFLD in persons with the PNPLA3 rs738409:G allele. The rs72613567:TA allele contributes to NAFLD disparities among Hispanic/Latino background groups. See Editorial on Page 756 [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease contributes to cognitive impairment and dementia, particularly among populations facing health disparities. However, the long‐term effects of cardiovascular health on later cognitive health have not been examined among Hispanics/Latinos. Therefore, we examined relationships between cardiovascular health with change in cognition and mild cognitive impairment (MCI) among diverse Hispanics/Latinos. Method: Hispanics/Latinos (n = 6,223, ages 50‐86 years) were enrolled in the Study of Latinos ‐ Investigation of Neurocognitive Aging (SOL‐INCA), an ancillary study of the Hispanic Community Health Study/SOL (HCHS/SOL). Cardiovascular health was the primary exposure, measured using the American Heart Association's Life's Simple 7s (LS7). Outcomes of interest included 7‐year performance in cognition, change in cognition, and MCI prevalence. Cognitive outcomes included measures of learning and memory, verbal fluency, executive functioning and processing speed, and a global composite (average of the z‐scores on each test). Survey linear regressions were used to separately model the associations between LS7 with outcomes of interest, controlling for age, age2, education, language preference, Hispanic/Latino background, and income. Results: Better cardiovascular health (higher LS7 Score) was associated with higher global cognitive performance (βGlobal = 0.028 [SE = 0.005], p<0.001). These associations were evident in learning (βB‐SEVLT‐Sum = 0.024 [SE = 0.007], p<0.01), memory (β = 0.024B‐SEVLT‐Recall [SE = 0.008], p<0.01), verbal fluency (β = 0.039WF [SE = 0.008], p<0.001), executive functioning and processing speed (βDSS = 0.027 [SE = 0.007], p<0.001 and βTrails A = ‐0.022 [SE = 0.007], p<0.01). We also observed significant associations between better cardiovascular health and improved global cognitive change (β = 0.023 [SE = 0.008], p<0.01), evident also for learning (βB‐SEVLT‐Sum = 0.017 [SE = 0.008], p<0.05), executive functioning and processing speed (βDSS = 0.034 [SE = 0.008], p<0.001). Lastly, better cardiovascular health decreased the odds ratios for prevalent MCI (ORMCI = 0.90 [0.842, 0.959], p<0.01). Conclusion: Cardiovascular health was protective of 7‐year cognitive aging and associated with reduced MCI prevalence. Our findings suggest that cardiovascular health may improve resilience to cognitive decline and impairment amongst diverse Hispanics/Latinos, which could prove instrumental in public health efforts for reducing dementia disparities facing Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Background: Lifetime risk for Alzheimer's disease is higher among women than men, and reproductive health factors may contribute to differential risk. Reproductive health and cognitive aging among Hispanic women/Latinas is understudied, so we examined such relationships in the Hispanic Community Healthy Study/Study of Latinos (HCHS/SOL) and the SOL‐Investigation of Neurocognitive Aging (SOL‐INCA). Method: The sample included Hispanic/Latina post‐menopausal women (n = 1,903, baseline age 44‐74 years). Exposures included oral contraceptive use, number of live births (parity), number of pregnancies, age at menarche, age at menopause, and reproductive span (years with menses). Outcomes included visit 2 cognitive performance (7‐years after baseline on average), 7‐year cognitive change (reliable change index), and NIA‐AA criteria mild cognitive impairment (MCI) prevalence. Cognitive measures included verbal learning and memory, verbal fluency, executive functioning (Trail B, higher scores = worse performance), and processing speed (Digit Symbol Substitution = DSS; Trail A, higher scores = worse performance), and a global composite (average of all individual z‐scores). Survey linear regressions were used to separately model the associations between reproductive health measures and outcomes, controlling for baseline age, education, language preference, Hispanic/Latina background, field center, income, birthplace, marital status, insurance status, and body mass index. Result: Performance at visit 2: Oral contraceptive use was associated with higher global cognitive performance (β = 0.129 [SE = 0.043], p<0.01), learning (β = 0.197 [SE = 0.062], p<0.01), and processing speed (βDSS = 0.147 [SE = 0.049], p<0.01 and βTrailA = ‐0.142 [SE = 0.071], p<0.05) than non‐use. Higher parity was associated with worse executive functioning (β = 0.035 [SE = 0.017], p<0.05) and processing speed (βDSS = ‐0.054 [SE = 0.015], p<0.001). 7‐year (average) cognitive change: Oral contraceptive use, higher parity, and higher pregnancies were each protective against change in learning (β = 0.147 [SE = 0.064], β = 0.040 [SE = 0.019], and β = 0.034 [SE = 0.014], respectively; all ps<0.05). Older age at menarche was protective against change in global cognition (β = 0.045 [SE = 0.016], p<0.01), learning (β = 0.035 [SE = 0.017], p<0.05) and memory (β = 0.037 [SE = 0.017], p<0.05). MCI: No exposures were associated with MCI. Conclusion: Reproductive health was linked to later life cognition among diverse Hispanic/Latina women. Future work should examine potential hormonal (e.g., estrogen) mechanisms. Although not associated with MCI In the present study, reproductive health may be linked to MCI status as the cohort ages and more women transition to MCI or dementia. [ABSTRACT FROM AUTHOR]

Background: Hearing impairment among Hispanics/Latinos has been associated with poorer cognition, potentially increasing mild cognitive impairment (MCI) and dementia risk. We aimed to examine associations between baseline hearing impairment with 1) cognition at visit 2 (7‐years later, on average), 2) 7‐year average change in cognition, and 3) mild cognitive impairment (MCI) at visit 2 among diverse Hispanics/Latinos. Method: Hispanics/Latinos (n = 6031, average baseline age 56.4‐years) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were enrolled in the SOL ‐ Investigation of Neurocognitive Aging (SOL‐INCA) ancillary study. Hearing impairment was defined as a pure tone average (500, 1,000, 2,000, 4,000 Hz) >25 dBHL in the better ear. Cognitive testing was performed at Visit 1 and again an average of 7‐years later. Tests included measures of learning and memory, verbal fluency, and executive functioning and processing speed, and global cognition (a z‐score composite from averaging each test). MCI was calculated based on NIA‐AA criteria. Survey linear regressions were used to separately model the associations between hearing impairment with outcomes of interest, controlling for age, gender, education, Hispanic/Latino background, field center, marital status, depressive symptoms, income, and Framingham cardiovascular disease risk. Result: Performance at visit 2: In fully adjusted models, hearing impairment at baseline was associated with lower scores in global cognition (B = ‐0.12; SE = 0.03; p<0.0001) evident in learning, memory and verbal fluency, but not executive function or processing speed at visit 2 (7 years later). 7‐year (average) cognitive change: Hearing impairment was associated with significant change (declines) in processing speed (B = ‐0.12; SE = 0.06; p<0.05) but not with change in global cognition or other cognitive domains. MCI: Hearing impairment was not associated with prevalent MCI. Conclusion: We found that hearing impairment was related to lower cognitive function and increased cognitive decline compared to Hispanics/Latinos with normal hearing. Hearing impairment was not associated with MCI among Hispanics/Latinos, and further longitudinal data are needed to determine if this holds as the cohort continues to age. Future studies should also examine comorbid sensory impairments and type of hearing impairments (noise induced hearing loss, conductive, sensorineural) with cognitive trajectories and MCI risk. [ABSTRACT FROM AUTHOR]

Background: Many aging Hispanic/Latino persons are worried about memory loss. Prior research suggests that subjective cognitive decline (SCD) and depression, might have common pathways, and could be precursors to cognitive impairment. We examined associations between depression and domains of SCD in a large sample of diverse Hispanics/Latinos. Methods: Data included n = 6,189 (unweighted) middle‐aged and older Hispanics/Latinos (Age M = 63.4‐years, SD = 8.2; 55% female; 40.5% with more than High School education) from 6‐heritage groups participating in the Study of Latinos‐Investigation of Neurocognitive Aging (SOL‐INCA), an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We used survey generalized linear regression to model the associations between depressive symptoms, captured at baseline (2008‐2011) with the Center for Epidemiological Studies‐Depression 10‐Item Scale (CES‐D‐10), and SCD was measured, on average 7‐years later, via the Everyday Cognition Short‐Form (ECog‐12). Results: Higher depressive symptoms at baseline were linked to worse global (B =.37, SE =.02) and domain specific SCD [Memory (B =.34, SE =.02), Visual Spatial Planning (B =.28, SE =.02), Executive (B =.33, SE =.02)] (ps<0.001) after adjusting for cardiovascular risk and demographic covariates. These associations were more pronounced in individuals who were concerned about their attention, concentration or memory. Hispanic/Latino background (i.e., Dominican, Central American, Cuban, Mexican, Puerto‐Rican, South American, Other) did not modify the associations between depression symptoms and measures of SCD (ps>0.05). Conclusion: Elevated depressive symptoms were consistently linked to global and domain specific subjective cognitive decline across Hispanics/Latinos of diverse heritages, particularly in the presence of attention, concentration or memory concerns. Our findings underscore the importance of assessing depression when evaluating Hispanics/Latinos with cognitive complaints. [ABSTRACT FROM AUTHOR]

Background: Neuropsychological assessment plays an important role in identifying mild cognitive impairment and dementia; demographically appropriate norms are essential for interpreting test performance and maximizing diagnostic accuracy. Limited availability of normative data for cognitive tests administered to older Hispanic/Latino adults can lead to diagnostic error. Executive functioning and information processing speed are crucial elements of neuropsychological assessment. To meet the needs of the Hispanic/Latino population, we investigated the associations of age, education, ethnic background, gender, and language on the Digit Symbol Substitution (DSS) test – a subtest of the WAIS‐R – and to provide demographically adjusted norms for a diverse group of Hispanics/Latinos. Method: The target population for the Study of Latinos‐Investigation of Neurocognitive Aging (SOL‐INCA; 2015–2018) included individuals from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds (n = 6,172). Average age was 63.4±8.3 years, 54.5% were female, and mean education was 11.0±4.6 years. The DSS was administered as part of a larger cognitive protocol in participants' preferred language (English or Spanish). Lower scores on the DSS are associated with slower processing speed. Demographic adjusted DSS scores, and percentile cut‐points were created using survey‐adjusted regression and quantile regression models. Result: In covaried regression models, each year increase in age was associated with B = ‐0.54 (p<0.001) units decrease in DSS scores, and each additional year of education with B = 1.42 (p<0.001) units increase in performance. Males had, on average, lower DSS scores than females (B = ‐2.41; p<0.001), and individuals with English as their preferred language performed better than those preferring Spanish (B = 6.18; p<0.001). DSS performance varied significantly by Hispanic/Latino background with, predominantly, Mexicans scoring highest and Dominicans lowest on the DSS. Conclusion: While other norms for Hispanic/Latino populations exist, results from this study represent the largest and only norms for Hispanic/Latinos living in the US. Representative DSS test norms for diverse groups of US‐based Hispanics/Latinos will advance cognitive assessment and the accuracy of neurocognitive disorder diagnosis in this country. We have developed an online dashboard to facilitate potential clinical use and interpretation (https://solincalab.shinyapps.io/DSST/) [ABSTRACT FROM AUTHOR]

Objective: Associations of IRS1 genetic variation with adiposity and metabolic profile in U.S. Hispanic/Latino individuals of diverse backgrounds were examined.Methods: Previously genome-wide association study-identified IRS1 variants (rs2943650, rs2972146, rs2943641, and rs2943634) as related to body fat percentage (BF%) and multiple metabolic traits were tested among up to 12,730 adults (5,232 men; 7,515 women) from the Hispanic Community Health Study/Study of Latinos.Results: The C-allele (frequency = 26%) of rs2943650 was significantly associated with higher BF% overall (β = 0.34 ± 0.11% per allele; P = 0.002) and in women (β = 0.41 ± 0.14% per C-allele; P = 0.003), but not in men (β = 0.28 ± 0.18% per C-allele; P = 0.11), though there was no significant sex difference. Using the inverse normal-transformed data to compare effect sizes, it was found that the association with BF% was stronger in Hispanic/Latino women than that previously reported in European women (β = 0.054 ± 0.018SD vs. β = 0.008 ± 0.011SD per C-allele; P = 0.03). The BF%-increasing allele of rs2943650 was significantly associated with lower levels of fasting insulin, homeostatic model assessment of insulin resistance, hemoglobin A1c, and triglycerides and higher high-density lipoprotein cholesterol (P < 0.05).Conclusions: This study confirmed and extended previous findings of IRS1 variation associated with increased adiposity but a favorable metabolic profile in U.S. Hispanics/Latinos, with a relatively stronger genetic effect on BF% in Hispanic/Latino women compared with European women. [ABSTRACT FROM AUTHOR]

Background: Psychosocial factors including intrapersonal and interpersonal resources and social stressors are associated with changes in cognition in older non‐Hispanic whites and Blacks. Few studies have examined these associations in Hispanics/Latinos, the largest ethnic/racial group in the US, or evaluated ethnically‐based psychosocial factors that may be more relevant to this population. We examined whether psychosocial factors predict seven‐year cognitive changes among US Hispanics/Latinos. Method: Data from the parent HCHS/SOL, and Sociocultural and SOL‐Investigation of Neurocognitive Aging ancillary studies were used (n= 2,158; ages 45+). Baseline psychosocial factors included: intrapersonal factors (optimism; purpose in life), interpersonal factors (family cohesion; social network embeddedness; social support), social stressors (loneliness; subjective social status), and ethnically‐based factors (ethnic identity; familism; perceived ethnic discrimination). Outcomes were changes in individual test scores for episodic learning and memory (B‐SEVLT‐Sum and SEVLT‐Recall), word fluency (WF), and processing speed (Digit Symbol Substitution, DSS) derived using regressions adjusting for time between assessments. Survey linear regression models were used to examine the associations between each psychosocial factor (z‐scores) and 7‐year changes in cognitive outcomes adjusting for age, sex, education, income, Hispanic/Latino background, language preference, and depressive symptoms. Result: Mean age was 55.9±7.9 years; females 54% of target population. Higher (baseline) levels of familism [(βSEVLT‐Sum (SE))= ‐0.08 (0.03), P<0.05)] predicted seven‐year decline in verbal learning. Higher optimism [βSEVLT‐Recall= 0.09 (0.03), P<0.01], social support [βSEVLT‐Recall= 0.07 (0.03), P<0.05], and ethnic identity [βSEVLT‐Recall= 0.06 (0.03), P<0.05] each predicted increase in memory. Higher familism [βSEVLT‐Recall= ‐0.08 (0.03), P<0.05] and loneliness [βSEVLT‐Recall= ‐0.06 (0.03), P<0.05] each predicted decline in memory. Higher purpose in life [βWF= 0.07 (0.03), P<0.05] predicted increase in word fluency. Higher family cohesion [βDSS= ‐0.08 (0.03, P<0.01) predicted decline in processing speed. Social network embeddedness, subjective social status, and perceived ethnic discrimination were not associated with any outcome. Conclusion: Psychosocial factors differentially related to changes in cognition. Results confirm previous studies in non‐Hispanic whites on associations of optimism, purpose in life, social support, and loneliness with select cognitive tests. They also highlight that ethnic identity and familism are ethnically‐based psychosocial factors that should be considered when examining healthy cognitive aging in US Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Background: Hispanics/Latinos in the United States vary widely in their levels of acculturation (adoption of Anglo‐American culture) which may have implications for cognitive functioning in older age. We aimed to characterize the relationships of acculturation with cognition and cognitive change among diverse U.S. Hispanics/Latinos. Method: Selected Hispanics/Latinos (unweighted n=5,901; ages 50+ years) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were enrolled in the Study of Latinos ‐ Investigation of Neurocognitive Aging (SOL‐INCA) ancillary study. Three measures of acculturation were collected at baseline (Short Acculturation Scale for Hispanics (SASH) – Social and Language subscales (Marin et al., 1987) and MESA Acculturation score (Kandula et al., 2008). On all measures higher scores reflect greater acculturation. Cognition was measured at two time‐points, on average, 7‐years apart. Global cognition based on a composite measure from learning and memory, executive functioning, and processing speed tests at the second testing was the main outcome of interest in addition to change in global scores. Survey linear regressions were used to separately model the associations between acculturation measures (quartiles) and cognitive outcomes (z‐scores), controlling for baseline age, sex, education, Hispanic/Latino background, field center, income, marital status, and insurance status. Result: Average age of the target population was 63.3 ± 8.3(SD) years, 55% were female, 39% reported less than high school education, and 43% were currently uninsured. Adjusting for covariates, the least acculturated (lowest quartile) according to the SASH had lower global cognition compared to all other groups (all p‐values<0.01; Social subscale: b=0.10; SE=0.03, b=0.15; SE=0.03, and b=0.13; SE=0.03, for the 2nd, 3rd, and 4th quartiles respectively; Language subscale: b=0.15; SE=0.03, b=0.12; SE=0.03, and b=0.23; SE=0.03). Individuals with the lowest MESA acculturation quartile had lower global cognition relative to those with scores in the highest quartile only (b=0.13; SE=0.04; p<0.01). None of the acculturation indices were associated with global cognitive change. Associations with domain specific cognitive outcomes were largely similar in pattern. Conclusion: Acculturation may be indicative of baseline differences in cognition rather than risk for cognitive change. Alternatively, acculturation‐based distinctions in cognition may be related to differences in familiarity with testing environments or approaches to cognitive tasks. [ABSTRACT FROM AUTHOR]

Background: Hispanics/Latinos have high prevalence of cardiovascular disease (CVD) risk factors which increases risk for stroke. However, the downstream impacts of CVD risk and stroke on brain structure in aging Hispanics/Latinos remains largely unknown. We compared Hispanic/Latino brain aging by CVD risk and stroke. Method: Hispanics/Latinos (nunweighted=1,156, 50‐85 years) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) underwent magnetic resonance imaging (MRI) as part of the Study of Latinos ‐ Investigation of Neurocognitive Aging‐MRI (SOL‐INCA‐MRI) ancillary study. Outcomes included global (gray matter, total brain) and regional (lobar cortices, hippocampal) brain, lateral ventricle (log‐transformed), and total white matter hyperintensity (WMH; log‐transformed) volumes residualized for total cranial volume. Ten‐year CVD risk at visit 2 (before MRI) was determined by Framingham Risk Score and recoded into three groups (Low (<10%), Medium (10‐<20%) and High (20+%)). Stroke (yes, no) was based on self‐report of ≥1 strokes or transient ischemic attacks at visit 1 and/or 2. Linear regression models tested 1) whether CVD risk or presence of stroke modified the relationship between age and MRI outcomes, and 2) whether CVD risk or stroke related brain aging differed by sex. All models adjusted for height and Hispanic/Latino background. Result: Sample was 64.3± 7.1 years old on average (nunweighted=798 women). High CVD risk was inversely associated with total brain (standardized beta β=–0.26; p<0.001), total gray (β=‐0.23; p=0.006), frontal (β = ‐0.33; p<0.001) and parietal cortical gray (β =‐0.28; p=0.002) matter volumes and positively associated with (log) lateral ventricle (β log=0.23; p=0.006) and (log) WMH (βlog =0.42; p<0.001) volumes. Stroke/TIA (nunweighted=48) showed a similar profile of associations but only the associations with (log) lateral ventricle (βlog=0.27; p=0.049) and (log) WMH (βlog=0.44; p=0.001) reached significance. Accelerated brain aging (age slope modification) through CVD risk and stroke was evident for total brain volume but less so for other MRI outcomes, and equivalently so across sexes. Conclusion: Among Hispanics/Latinos, CVD risk and stroke are associated with poorer brain health across brain MRI indicators. Additionally, CVD risk and stroke may accelerate overall brain aging for both Hispanic/Latino men and women as determined by total brain volumes. [ABSTRACT FROM AUTHOR]

Background: The older Hispanic/Latino population in the U.S. is projected to grow faster than any racial/ethnic group in the country. Little is known about brain aging in this population, and we remain poorly equipped to detect and track brain changes in this population. We characterized brain aging in a sample of Hispanics/Latinos from diverse backgrounds and investigated differences by sex. Method: Nunweighted=1,389 Hispanics/Latinos (ages 39‐85 years; 66% female) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) underwent brain magnetic resonance imaging (MRI) as part of the Study of Latinos ‐ Investigation of Neurocognitive Aging MRI (SOL‐INCA MRI) ancillary study. MRI outcomes of interest included global (gray matter, total brain) and regional (lobar cortices, hippocampus) brain volumes, lateral ventricle volume, and total white matter hyperintensity (WMH) volume. All MRI measures were residualized for total cranial volume prior to calculating brain aging trajectories using linear regressions that included sex, height, and Hispanic/Latino background as terms in the model. We also tested for effect modification by sex. Result: Mean age was 60.8± 10.3 years. Age was associated with decrements in total (βtotal=‐0.66; p<0.001) and hippocampal volumes (βhippocampus=‐0.20; p<0.001) as well as incremental enlargements in lateral ventricle and WMH volumes (βlog_lateralvent=0.48; p<0.001; βlog_WMH=0.54; p<0.001). Age was also inversely linked to total brain gray matter as well as all lobar cortical gray matter volumes. Age‐related decrements in total and regional brain volumes, but not lateral ventricle or WMH, were exacerbated in men relative to women (all p<0.05). Adjusting for height and background, women had larger total brain (standardized beta βtotal=0.27; p<0.001), frontal (βfrontal=0.27; p<0.001), and parietal (βparietal=0.17; p=0.025) volumes, smaller hippocampal and lateral ventricle volumes, and larger gray matter volumes, but did not differ in WMH as compared to men. Conclusion: These findings suggest that increasing age is associated with smaller regional MRI brain measures in Hispanic/Latino individuals. Aging patterns in gray matter volumes appeared to be exacerbated among men compared to women whereas age‐related differences in lateral ventricular volume and white matter hyperintensities were consistent between sexes. Our findings help establish the trajectories of brain aging among middle‐aged and older Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Diabetes prevalence is rising rapidly, and diabetes disproportionately affects Hispanics and other underserved groups. Chronic stress may contribute to diabetes risk, but few studies have examined this relationship in U.S. Hispanics. We examined associations of chronic stress with fasting glucose, glucose tolerance, and glycosylated hemoglobin (HbA1c) in Hispanics without diabetes, and also assessed indirect effects of stress through inflammation (CRP). Participants were 3,923 men and women, aged 18-74, without diabetes, from the four U.S. field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary study. Participants completed a measure of chronic life stress and a physical exam with oral glucose tolerance test. In a multivariate regression analysis with adjustment for demographic and health covariates, higher chronic stress was related to higher fasting glucose (standardized regression coefficient: β = .09, p < .01), postload glucose (β = .07, p < .05), and HbA1c levels (β = .08, p < .01). However, there was no indirect effect of stress through inflammation. Findings suggest that higher chronic stress is associated with poorer glucose regulation in Hispanics, prior to the onset of a clinical diabetes diagnosis. [ABSTRACT FROM AUTHOR]

Objective To test the hypothesis that greater chocolate-candy intake is associated with more weight gain in postmenopausal women. Methods A prospective cohort study involved 107,243 postmenopausal American women aged 50-79 years (mean = 60.7) at enrollment in the Women's Health Initiative, with 3-year follow-up. Chocolate-candy consumption was assessed by food frequency questionnaire, and body weight was measured. Linear mixed models, adjusted for demographic, socio economic, anthropomorphic, and behavioral variables, were used to test our main hypotheses. Results Compared with women who ate a 1 oz (∼28 g) serving of chocolate candy <1 per month, those who ate this amount 1 per month to <1 per week, 1 per week to < 3 per week and ≥3 per week showed greater 3-year prospective weight gains (kg) of 0.76 (95% CI: 0.66, 0.85), 0.95 (0.84, 1.06), and 1.40 (1.27, 1.53), respectively, ( P for linear trend<0.0001). Each additional 1 oz/day was associated with a greater 3-year weight gain (kg) of 0.92 (0.80, 1.05). The weight gain in each chocolate-candy intake level increased as BMI increased above the normal range (18.5-25 kg/m2), and was inversely associated with age. Conclusions Greater chocolate-candy intake was associated with greater prospective weight gain in this cohort of postmenopausal women. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment, dementia, and Alzheimer's disease (AD) have higher rates in the Hispanic population compared to non‐Hispanic Whites. APOE alleles are the strongest known genetic predictors for AD, however, in the Hispanic population, the effect appears to be weaker, and inconsistent between studies. We hypothesized that this heterogeneity is due, in part, to ancestry‐specific genetic effects. Method: We investigated the associations of APOE alleles with cognitive decline and mild cognitive impairment (MCI), determined by longitudinal cognitive assessment 1. The study population included 4,250 individuals from the SOL‐INCA study, a subset of middle‐aged and older adults' from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We further stratified and explored these associations within six different Hispanic background groups: Cuban, Dominican, Mexican, Puerto‐Rican, South‐American, and Central‐American. Finally, we performed interaction analysis to study the hypothesis that proportion genetic ancestry (European, African and Amerindian) modifies the effect of the APOE alleles on the neurocognitive functions. Result: The APOE ε4 allele was associated with both global cognitive decline (Beta=‐0.11, p‐value= 0.01) and a status of 'cognitive decliner', defined when global cognitive decline is higher than expected in normal cognitive aging, (OR=1.15, p‐value=0.03). After stratification by background groups, these associations remained significant only for Cubans showing a stronger effect relative to the effect in the total population (Decliners: OR= 1.46, p‐value= 0.007, global cognitive decline: Beta= ‐0.25, p‐value= 0.01). Stratification analysis also revealed new associations showing protective effects on MCI and cognitive decline by the APOE ε2 allele in two of the Hispanic background groups: Dominican and Puerto‐Rican. Heterogeneity tests suggest a significant differential effect for global cognitive decline for both APOE ε2 (p‐value <0.001) and APOE ε4 (p‐value <0.05). Interaction analysis suggests that increased proportion of African genetic ancestry was associated with a more protective effect conferred by APOE ε2 on global cognitive decline. Also, an increased proportion of Amerindian genetic ancestry was associated with lower risk effects conferred by APOE ε4 on both decline phentoypes. Conclusion: These results suggest that APOE alleles' effects on neurocognitive functions differ across the six Hispanic genetic backgrounds and are modified by ancestry‐specific genetic effects. [ABSTRACT FROM AUTHOR]

Background: Subjective cognitive decline (SCD) is the experience of cognitive decline not yet apparent through formal neuropsychological testing. SCD is required to meet clinical criteria for mild cognitive impairment (MCI) and is a potential early risk marker of neurocognitive changes. Despite increased risk of cognitive decline in US Hispanics/Latinos, SCD research in this group is lacking. We investigated if SCD is cross‐sectionally associated with objective neurocognitive performance in SOL‐INCA, a large community‐based sample of diverse Hispanics/Latinos. Method: Participants (N=5,282) were age 50+ and without reported dementia. The Everyday Cognition Short Form (ECog‐12) scale measured SCD. A global score, as well as memory and executive ECog‐12 sub‐scale scores, were calculated by averaging across z‐scores of individual items assessing memory and executive functional abilities (all items were averaged for the global score). Objective neurocognitive function was measured with tests of memory (Spanish English Verbal Learning Test‐Sum and Recall scores) and executive functions (word fluency, Trail Making Test A & B, and Digit Symbol Substitution scores). Memory, executive, and global neurocognitive composite scores were created by averaging across z‐scores for each cognitive domain listed above, and across all tests for the global composite. Regression models interrogated associations of ECog‐12 (global and sub‐scale scores) with their respective objective neurocognitive function counterparts (global cognition, memory, and executive function neurocognitive composite scores), adjusting for age, sex, education, Hispanic/Latino background, depression, anxiety, and cardiovascular risk factors. Result: Women comprised 53% of the sample and 25% of the sample were age 70+. Global score, memory, and executive sub‐scale ECog‐12 scores were significantly associated with global (B= ‐0.14), memory (B= ‐0.11), and executive function (B= ‐0.11) neurocognitive composite scores respectively (all p‐values <.001), such that higher ECog‐12 scores (more complaints) were related to lower neurocognition for all three neurocognitive composites. Conclusion: Contrary to previous research in non‐Hispanic Whites, SCD is associated with concurrent objective neurocognitive function among Hispanic/Latino community‐dwelling adults. SCD may have utility as an early risk marker in this population. More research is needed to determine the predictive value of SCD reporting within Hispanics/Latinos as well as the utility of informant's report in predicting neurocognitive change. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular and cerebrovascular health problems significantly increase risk for Alzheimer's Disease and Related Dementias (ADRDs), and Hispanics/Latinos are arguably at higher risk for ADRDs compared to Whites. Middle‐age may be a crucial time in which cardiovascular health starts to notably impact cognition. Most research supporting connections between cardiovascular and cognitive health and ADRDs has been conducted with non‐Hispanic/Latino White samples. Diverse Hispanics/Latinos may differentially benefit from improvements in cardiovascular health to an equal or greater extent than Whites. The purpose of the study was to characterize the associations between mid‐life cardiovascular health and 7‐year change in cognition in diverse Hispanics/Latinos. Methods: We used prospective data from middle‐age and older Latinos (45‐74 years and older at Visit1; 2008‐2011) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Visit 1) who were cardiovascular disease‐free and stroke/TIA‐free at Visit1 (unweighted n=3,345) to examine relationships between baseline cardiovascular health, assessed using the multiethnic Global Vascular Risk Score (GVRS), and change in cognition from Visit1 to Visit2 (SOL‐INCA; 2016‐2018), an average of 7‐years later, and Mild Cognitive Impairment (MCI) prevalence at Visit2. In addition to MCI, cognitive outcomes included global and domain specific (verbal learning and memory, verbal fluency, executive functioning, attention, and psychomotor speed tasks) cognitive change. We fit survey generalized linear regressions to model the associations between the cardiovascular risk exposure and our cognitive outcomes and examined modifications by sex and age. Results: Adjusting for covariates, higher GVRS scores (10% increments) were associated with more pronounced decline (SD units) in global (β=‐0.35; SE=0.06; p<0.001) and domain specific cognitive performance. Higher GVRS scores were also associated with higher odds ratio of MCI (OR=1.59; 95% CI=[1.10;2.38]; p=0.023) at Visit 2. We found no statistical evidence to support sex or age modifications in the associations between GVRS, cognitive change, and MCI. Conclusion: Cardiovascular and stroke risk is associated with accelerated cognitive decline and an increased risk of MCI. Effects did not differ by age. These results raise the possibility that vascular risk factor modification in Hispanics/Latinos may promote successful cognitive aging and reduce the risk for MCI. [ABSTRACT FROM AUTHOR]

Background: Hispanics/Latinos are at increased risk for Alzheimer's disease and related dementias (ADRD). Impairments in both cognition and daily functioning are required to meet clinical criteria for ADRD. Poorer cognition and female sex have been associated with greater declines in daily functioning with age. However, predictors of daily functioning among older Hispanics/Latinos are seldom investigated. Method: Participants included 6292 cognitively healthy adults from the Study of Latinos ‐ Investigation of Neurocognitive Aging (SOL‐INCA), an ancillary study of a subset of participants 50+ years old in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cognitive data (learning and memory, executive functioning, processing speed) were collected at Visit 1 (HCHS/SOL). Daily functioning was assessed using the self‐rated version of the Instrumental Activities of Daily Living (IADL) questionnaire at Visit 2 (SOL‐INCA), an average of 7 years later. We used survey two‐part models (mixture of logit and generalized linear model with Gaussian distribution) and ordered logistic regression to examine whether cognitive performance (on individual tests and a cognitive composite z‐score) was associated with later functioning (risk of any impairment and degree of impairment) and tested for modifications by age (50‐59/60‐69/70+ years: Unweighted ns =2,659, 2,576, 1,057) and sex (male/female: Unweighted ns = 2239, 4053). Result: After covariates adjustment, higher Visit 1 global cognitive (z‐score units) performance (OR= 0.56; 95% CI=[0.47;0.67]; p<0.001), as well as higher domain specific cognitive function, were associated with lower risk of any IADL dysfunction at Visit 2. Associations were stronger for the oldest group (70+ years) relative to the youngest group (50‐59 years), and this was consistent for all measures, except word fluency. Sex did not modify any associations between cognition and later functioning. Across the full sample, higher scores on learning, memory, and the cognitive composite were also associated with lower degree of IADL impairment. Conclusion: Our findings confirm that cognitive health is an important predictor of everyday functioning among Hispanics/Latinos 7‐years later, especially in older adulthood. Additionally, IADL functioning among female Hispanics/Latinas was no more or less impacted by cognition as compared to their male counterparts. [ABSTRACT FROM AUTHOR]

Background: Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample., Methods and Results: We analyzed data from young adults, aged 18 to 39 years, with untreated BP <140/90 mm Hg at baseline from Kaiser Permanente Southern California (N=355 324). We used latent growth curve models to identify 10-year BP trajectories and to assess the associations between characteristics in young adulthood and BP trajectories. We identified the following 5 distinct systolic BP trajectories, which appeared to be determined mainly by the baseline BP with progressively higher BP at each year: group 1 (lowest BP trajectory, 7.9%), group 2 (26.5%), group 3 (33.0%), group 4 (25.4%), and group 5 (highest BP trajectory, 7.3%). Older age (adjusted odds ratio for 30-39 versus 18-29 years, 1.23 [95% CI, 1.18-1.28]), male sex (13.38 [95% CI, 12.80-13.99]), obesity (body mass index ≥30 versus 18.5-24.9 kg/m 2 , 14.81 [95% CI, 14.03-15.64]), overweight (body mass index 25-29.9 versus 18.5-24.9 kg/m 2 , 3.16 [95% CI, 3.00-3.33]), current smoking (1.58 [95% CI, 1.48-1.67]), prediabetes (1.21 [95% CI, 1.13-1.29]), diabetes (1.60 [95% CI, 1.41-1.81]) and high low-density lipoprotein cholesterol (≥160 versus <100 mg/dL, 1.52 [95% CI, 1.37-1.68]) were associated with the highest BP trajectory (group 5) compared with the reference group (group 2)., Conclusions: Traditional hypertension risk factors including smoking, diabetes, and elevated lipids were associated with BP trajectories in young adults, with obesity having the strongest association with the highest BP trajectory group.

Background: Adverse pregnancy outcomes, such as preterm birth (PTB), have been associated with elevated risk of maternal cardiovascular disease, but their effect on late midlife blood pressure (BP) and subclinical vascular measures remains understudied., Methods and Results: We conducted a cross-sectional analysis with 1220 multiethnic parous women enrolled in SWAN (Study of Women's Health Across the Nation) to evaluate the impact of self-reported history of adverse pregnancy outcomes (PTB, small-for-gestational-age, stillbirth), on maternal BP, mean arterial pressure, and subclinical vascular measures (carotid intima-media thickness, plaque, and pulse wave velocity) in late midlife. We also examined whether these associations were modified by race/ethnicity. Associations were tested in linear and logistic regression models adjusting for sociodemographics, reproductive factors, cardiovascular risk factors, and medications. Women were on average aged 60 years and 255 women reported a history of an adverse pregnancy outcome. In fully adjusted models, history of PTB was associated with higher BP (systolic: β=6.40; SE, 1.62 [ P <0.0001] and diastolic: β=3.18; SE, 0.98 [ P =0.001]) and mean arterial pressure (β=4.55; SE 1.13 [ P <0.0001]). PTB was associated with lower intima-media thickness, but not after excluding women with prevalent hypertension. There were no significant associations with other subclinical vascular measures., Conclusions: Findings suggest that history of PTB is associated with higher BP and mean arterial pressure in late midlife. Adverse pregnancy outcomes were not significantly related to subclinical cardiovascular disease when excluding women with prevalent hypertension. Future studies across the menopause transition may be important to assess the impact of adverse pregnancy outcomes on midlife progression of BP., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)