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Alzheimer's disease (AD) is a growing public health concern with large disparities in incidence and prevalence between African Americans (AAs) and non-Hispanic whites (NHWs). The aim of this review was to examine the evidence of association between six modifiable risk factors (education, smoking, physical inactivity, obesity, social isolation, and psychosocial stress) and Alzheimer's disease risk in AAs and NHWs. We identified 3,437 studies; 45 met inclusion criteria and were included in this review. Of the examined risks, education provided the strongest evidence of association with cognitive outcomes in AAs and NHWs. This factor may operate directly on Alzheimer's disease risk through the neurocognitive benefits of cognitive stimulation or indirectly through social status.

Objectives: Research has shown that stereotype threat can impair older adults' memory in Western cultures. We tested whether this also occurs for older adults from the East Asian Chinese culture. We also tested whether an intervention that highlighted Confucian principles would protect Chinese older adults from stereotype threat's detrimental effects., Method: Culturally-Chinese older adults residing in the United States completed a memory test either under age-based stereotype threat about cognitive decline or not. Prior to this, some participants were also reminded of Confucian traditions of filial piety and were assured these values had been transmitted to the younger generation., Results: Stereotype threat impaired Chinese older adults' memory performance. However, our intervention was effective in eliminating this deficit. When the Chinese participants were reminded of the Confucian principle of filial piety they did not exhibit stereotype threat effects., Discussion: Confirming that younger adults have an obligation to respect their elders can eliminate the social-evaluative pressure of stereotype threat for Chinese older adults. These findings are noteworthy since population aging is happening at an unprecedented pace in East Asia. Although our results suggest that stereotype threat can adversely affect older adults' cognitive performance in these societies, we also identify a culturally-based intervention to alleviate this impairment., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: A well-documented paradox is that Hispanics tend to live longer than non-Hispanic Whites (NHW), despite structural disadvantages. We evaluate whether the "Hispanic paradox" extends to more comprehensive longitudinal aging classifications and examine how lifecourse factors relate to these groupings., Methods: We used biennial data (1998-2014) on adults aged 65 years and older at baseline from the Health and Retirement Study. We use joint latent class discrete time and growth curve modeling to identify trajectories of aging, and multinomial logit models to determine whether U.S.-born (USB-H) and Foreign-born (FB-H) Hispanics experience healthier styles of aging than non-Hispanic Whites (NHW), and test how lifecycle factors influence this relationship., Results: We identify four trajectory classes including, "cognitive unhealthy," "high morbidity," "nonaccelerated", and "healthy." Compared to NHWs, both USB-H and FB-H have higher relative risk ratios (RRR) of "cognitive unhealthy" and "high morbidity" classifications, relative to "nonaccelerated." These patterns persist upon controlling for lifecourse factors. Both Hispanic groups, however, also have higher RRRs for "healthy" classification (vs "nonaccelerated") upon adjusting for adult achievements and health behaviors., Discussion: Controlling for lifefcourse factors USB-H and FB-H have equal or higher likelihood for "high morbidity" and "cognitive unhealthy" classifications, respectively, relative to NHWs. Yet, both groups are equally likely of being in the "healthy" group compared to NHWs. These segregations into healthy and unhealthy groups require more research and could contribute to explaining the paradoxical patterns produced when population heterogeneity is not taken into account., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: To determine if sleep-disordered breathing (SDB), daytime sleepiness, insomnia, and sleep duration predict seven-year neurocognitive decline in US Hispanics/Latinos (N = 5247)., Methods: The exposures were baseline SDB, daytime sleepiness, insomnia, and sleep duration. The outcomes were change in episodic learning and memory (B-SEVLT-Sum and SEVLT-Recall), language (word fluency [WF]), processing speed (Digit Symbol Substitution), and a cognitive impairment screener (Six-item Screener [SIS])., Results: Mean age was 63 ± 8 years, with 55% of the population being female with 7.0% Central American, 24.5% Cuban, 9.3% Dominican, 35.9% Mexican, 14.4% Puerto Rican, and 5.1% South American background. Long sleep (>9 hours), but not short sleep (<6 hours), was associated with decline (standard deviation units) in episodic learning and memory (β SEVLT-Sum = -0.22 [se = 0.06]; P < .001; β SEVLT-Recall = -0.13 [se = 0.06]; P < .05), WF (Pwf = -0.20 [se 5 0.06]; P < .01), and SIS (β SIS = -0.16 [se = 0.06]; P < .01), but not processing speed, after adjusting for covariates. SDB, sleepiness, and insomnia were not associated with neurocognitive decline., Conclusion: Long sleep duration predicted seven-year cognitive decline., (© 2019 the Alzheimer's Association.)

The global prevalence of Parkinson's disease is increasing, yet the characteristics, risk factors and genetics of PD in Black, Asian and Hispanic populations is little understood. In this paper we review the published literature on clinical variation in the symptoms and signs of Parkinson's disease in different ethnic groups and responses to treatment. We included any study that sampled patients with Parkinson's disease from distinct ethnic backgrounds. We conclude that whilst there is little published evidence for ethnic variation in the clinical features of Parkinson's disease, there are substantial limitations and gaps in the current literature, which mean that the evidence does necessarily not fit with clinical observation. Possible explanations for expected differences in manifestation include genetic determinants, the co-existence of cerebrovascular disease and/or Alzheimer's disease pathology, healthcare inequalities and socio-cultural factors.

Background: Mexican Americans suffer from a disproportionate burden of modifiable risk factors, which may contribute to the health disparities in mild cognitive impairment (MCI) and Alzheimer's disease (AD)., Objective: The purpose of this study was to elucidate the impact of comorbid depression and diabetes on proteomic outcomes among community-dwelling Mexican American adults and elders., Methods: Data from participants enrolled in the Health and Aging Brain among Latino Elders study was utilized. Participants were 50 or older and identified as Mexican American (N = 514). Cognition was assessed via neuropsychological test battery and diagnoses of MCI and AD adjudicated by consensus review. The sample was stratified into four groups: Depression only, Neither depression nor diabetes, Diabetes only, and Comorbid depression and diabetes. Proteomic profiles were created via support vector machine analyses., Results: In Mexican Americans, the proteomic profile of MCI may change based upon the presence of diabetes. The profile has a strong inflammatory component and diabetes increases metabolic markers in the profile., Conclusion: Medical comorbidities may impact the proteomics of MCI and AD, which lend support for a precision medicine approach to treating this disease.

The Rush Alzheimer's Disease Center (RADC) conducts 5 harmonized prospective clinical-pathologic cohort studies of aging - with 1 study, the Latino Core, focused exclusively on Latinxs, 2 studies consisting of mostly non-Latinx whites, and 2 studies of mostly non-Latinx blacks. This paper contextualizes the Latino Core within the other 4 harmonized RADC cohort studies. The overall aim of the paper is to provide information from the RADC, so that researchers can learn from our participants and procedures to better advance the science of Alzheimer's disease and related dementias in Latinxs. We describe an annual clinical evaluation that assesses risk factors for Alzheimer's dementia among older adults without known dementia at enrollment. As all RADC cohort studies offer brain donation as a part of research participation, we discuss our approach to brain donation and subsequent participant decision-making among older Latinxs. We also summarize baseline characteristics of older Latinxs across the 5 RADC cohort studies in relation to the baseline characteristics of non-Latinx blacks and non-Latinx whites. Finally, we outline challenges and considerations as well as potential next steps in cognitive aging research with older Latinxs., (© 2020 S. Karger AG, Basel.)

Background: There remains a lack of information and understanding of the prevalence and incidence of Alzheimer's disease and related dementia in Indigenous populations. Little evidence available suggests that Indigenous peoples may have disproportionately high rates of Alzheimer's disease and related dementia (ADRD)., Objective: Given this information, this study systematically explores what risk factors may be associated with ADRD in Indigenous populations., Methods: A search of all published literature was conducted in October 2016, March 2018, and July 2019 using Medline, Embase, and PsychINFO. Subject headings explored were inclusive of all terms related to Indigenous persons, dementia, and risk. All relevant words, phrases, and combinations were used. To be included in this systematic review, articles had to display an association of a risk factor and ADRD. Only studies that reported a quantifiable measure of risk, involved human subjects, and were published in English were included., Results: Of 237 articles originally identified through database searches, 45 were duplicates and 179 did not meet a priori inclusion criteria, resulting in 13 studies eligible for inclusion in this systematic review., Conclusion: The large number of potentially modifiable risk factors reported relative to non-modifiable risk factors illustrates the importance of socioeconomic context in the pathogenesis of ADRD in Indigenous populations. The tendency to prioritize genetic over social explanations when encountering disproportionately high disease rates in Indigenous populations can distract from modifiable proximal, intermediate, and distal determinants of health.

Background: Increasing research focuses on ethnic differences in Alzheimer's disease, but such efforts in other neurodegenerative dementias are lacking. Currently, data on the ethnic profile of cognitively impaired persons with Lewy body disease (LBD) is limited, despite Lewy body dementia being the second most common neurodegenerative dementia., Objective: The study aimed to investigate presenting characteristics among ethnoracially diverse individuals with cognitive impairment secondary to LBD using the National Alzheimer's Coordinating Center database., Methods: Participants self-identified as African American, Hispanic, or White. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in presenting characteristics and linear regression to compare neuropsychological test performance., Results: Presentation age was similar between groups (median 74-75 years). Compared to Whites (n = 1782), African Americans (n = 130) and Hispanics (n = 122) were more likely to be female and single, have less educational attainment, report more cardiovascular risk factors, describe less medication use, and perform worse on select cognitive tests. Hispanics reported more depressive symptoms., Conclusion: Cohorts differences highlight the need for population-based LBD studies with racial-ethnic diversity. Culturally-sensitive neuropsychological tests are needed to determine whether observed differences relate to cultural, social, testing, or disease-related factors. More research is needed regarding how social and biological factors impact LBD care among diverse populations.

Importance: Prior evidence suggests that racial differences exist in tau biomarkers in mild cognitive impairment (MCI) and Alzheimer disease (AD). Whether this reported disparity is associated with a differential level of neurodegeneration and disease stage or with underlying mechanisms separate from amyloid or tau is unclear., Objectives: To compare cerebrospinal fluid (CSF) biomarkers in African American and white individuals with normal cognition and MCI, to estimate race-based cutoffs for these biomarkers that maximize diagnostic discrimination between normal cognition and MCI, and to study the association of demographic characteristics, cognitive performance, and common vascular risk factors with these differences., Design, Setting, and Participants: This case-control study conducted from March 1, 2016, through January 31, 2019, included participants in the Brain Stress Hypertension and Aging Research Program cohort undergoing baseline assessment. Participants were 50 years or older and recruited from the Atlanta, Georgia, area., Exposures: Self-reported race and cognitive status categorized using modified Petersen criteria and clinical consensus diagnosis., Main Outcomes and Measures: Levels of β-amyloid 1-42 (Aβ1-42), tau, and phosphorylated tau 181 (pTau181), the ratio of tau or pTau181 to Aβ1-42, and hippocampal volume on magnetic resonance imaging of the brain., Results: Data from 362 study participants were analyzed (mean [SD] age, 65.6 [7.9] years), of whom 152 (42.0%) were African American, 230 (63.5%) were women, and 189 (52.2%) had MCI. After adjustment for demographic characteristics and cognitive performance, lower mean (SE) levels were observed in African American vs white individuals with MCI for tau (52.40 [5.90] vs 78.98 [5.02] pg/mL; P = .001) and pTau181 (15.42 [2.06] vs 25.24 [1.75] pg/mL; P = .001) and a lower pTau181 to Aβ1-42 ratio (0.07 [0.02] vs 0.14 [0.01]; P = .003). There were no racial differences in the normal cognition group or in hippocampal volumes in the MCI group. Cutoffs for CSF biomarkers were higher for Aβ1-42 in African American relative to white individuals (208 [95% CI, 126-321] vs 197 [95% CI, 183-245] pg/mL) and lower for tau (51 [95% CI, 31-59] vs 59 [95% CI, 56-92] pg/mL) and pTau181 (12 [95% CI, 12-19] vs 20 [95% CI, 12-27] pg/mL) levels. Cutoffs for the pTau181 to Aβ1-42 ratio were 0.05 (95% CI, 0.03-0.12) for African American participants and 0.05 (95% CI, 0.05-0.13) for white participants., Conclusions and Relevance: This study found that African American individuals had lower levels of tau-based biomarkers that were not likely explained by the degree of disease stage or neurodegeneration reflected by hippocampal volumes. This study suggests that race is an important factor when interpreting CSF biomarkers, especially in the clinical diagnosis of prodromal AD. It appears that using the pTau181 to Aβ1-42 ratio may ameliorate these differences.

Introduction: This study aimed to determine if later birth year influences trajectory of age-related cognitive decline across racial/ethnic groups and to test whether years of school, childhood socioeconomic status, and cardiovascular disease burden explain such secular trends., Methods: We compared cognitive trajectories of global cognition and subdomains in two successive racially/ethnically and educationally diverse birth cohorts of a prospective cohort study., Results: Later birth year was associated with higher initial cognitive levels for Whites and Blacks, but not Hispanics. Later birth year was also associated with less rapid rate of decline in all three racial/ethnic groups. More years of education, higher childhood socioeconomic status, and, to a smaller extent, greater cardiovascular disease burden accounted for higher intercepts in the later-born cohort, but did not account for attenuated slope of cognitive decline., Discussion: Later birth year is related to a slower rate of age-related decline in some cognitive domains in some racial/ethnic groups. Our analyses suggest that racial/ethnic and social inequalities are part of the mechanisms driving secular trends in cognitive aging and dementia., (Copyright © 2019 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To aid primary care providers in identifying people at increased risk for cognitive decline, we explored the relative importance of health and demographic variables in detecting potential cognitive impairment using the Mini-Mental State Examination (MMSE). Participants were 94 older African Americans coming to see their primary care physicians for reasons other than cognitive complaints. Education was strongly associated with cognitive functioning. Among those with at least 9 years of education, patients with more vascular risk factors were at greater risk for mild cognitive impairment. For patients with fewer than 9 years of education, those with fewer prescribed medications were at increased risk for dementia. These results suggest that in addition to the MMSE, primary care physicians can make use of patients' health information to improve identification of patients at increased risk for cognitive impairment. With improved identification, physicians can implement strategies to mitigate the progression and impact of cognitive difficulties.

Objectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations., Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at <25th percentile (Low Average), <10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses., Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors., Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.

Objectives: Low educational attainment is a risk factor for more rapid cognitive aging, but there is substantial variability in cognitive trajectories within educational groups. The aim of this study was to determine the factors that confer resilience to memory decline within educational strata., Methods: We selected 2573 initially nondemented White, African American, and Hispanic participants from the longitudinal community-based Washington Heights/Inwood Columbia Aging Project who had at least two visits. We estimated initial memory (intercept) and the rate of memory decline (slope) using up to five occasions of measurement. We classified groups according to the educational attainment groups as low (≤5 years), medium (6-11 years), and high (≥12 years). We used a multiple-group latent growth model to identify the baseline predictors of initial memory performance and rate of memory decline across groups. The model specification considered the influence of demographic, socioeconomic, biomedical, and cognitive variables on the intercept and the slope of memory trajectory., Results: Our results indicated that the three educational groups do not benefit from the same factors. When allowed to differ across groups, the predictors were related to cognitive outcomes in the highly educated group, but we found no unique predictor of cognition for the low educated older adults., Conclusions: These findings highlight that memory-protective factors may differ across older adults with distinct educational backgrounds, and the need to evaluate a broader range of potential resilience factors for older adults with few years of school.

Research on marital status-gender differences in later-life trajectories of cognitive functioning is scarce. Drawing on seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, this research uses growth curve models to examine later-life dynamics of cognitive functioning among married and widowed older men and women of Mexican descent (aged 65+; N = 3329). The findings demonstrate that the widowed, regardless of gender, had lower initial levels of cognition but a less steep cognitive decline across waves, compared to married men. Age and socioeconomic resources accounted for these marital status differences in levels and rates of change in cognitive functioning completely among widowed men and partially among widowed women. Moreover, net of all the factors, married women had a slower cognitive decline than married men. This study also shows that health and social integration might shape cognitive functioning among older adults of Mexican descent.

Objective: The present study investigated the ability of the Multilingual Naming Test (MINT), a picture naming test recently added to the National Alzheimer's Coordinating Center's (NACC) Uniform Data Set neuropsychological test battery, to detect naming impairment (i.e., dysnomia) across stages of Alzheimer's disease (AD)., Method: Data from the initial administration of the MINT were obtained on NACC participants who were cognitively normal (N = 3,981) or diagnosed with mild cognitive impairment (N = 852) or dementia (N = 1,148) with presumed etiology of AD. Dementia severity was rated using the Clinical Dementia Rating (CDR) scale., Results: Cross-sectional multiple regression analyses revealed significant effects of diagnostic group, sex, education, age, and race on naming scores. Planned comparisons collapsing across age and education groups revealed significant group differences in naming scores across levels of dementia severity. ROC curve analyses showed good diagnostic accuracy of MINT scores for distinguishing cognitively normal controls from AD dementia, but not from MCI. Within the cognitively normal group, there was a robust interaction between age and education such that naming scores exhibited the most precipitous drop across age groups for the least educated participants. Additionally, education effects were stronger in African-Americans than in Whites (a race-by-education interaction), and race effects were stronger in older than in younger age groups (a race-by-age interaction)., Conclusions: The MINT successfully detects naming deficits at different levels of cognitive impairment in patients with MCI or AD dementia, but comparison to age, sex, race, and education-corrected norms to determine impairment is essential.

Background: Limited information is available from longitudinal studies regarding the predictors and incidence of MCI in older Asian adults. Thus, a community-based longitudinal study was conducted to determine the incidence of MCI among multi-ethnic older adults in Malaysia. The role of health and lifestyle as predictors of MCI was also examined., Methods: Analysis of data obtained from the Towards Useful Aging (TUA) study (2014-2016), wave 1 (baseline) and wave 2 (1½ years of follow-up) was conducted. For the baseline, comprehensive, interview-based questionnaires were administered to 1227 subjects who were 60 years old and above. MCI is a unique transitional state between normal ageing and dementia. MCI characteristics include a decline and disturbance of cognition, minimal impairment of complex activities, ability to perform regular daily functions, and absence of dementia. The incidence of MCI was assessed using comprehensive neuropsychological batteries. The study then performed a logistic regression analysis to examine the effect of each possible predictor of MCI. This analysis began with univariate analyses and a separate review of the effect of every variable. Binary logistic analyses followed hereafter., Results: During the follow-up after 1½ years, 179 (14.6%) of the participants who did not exhibit MCI at baseline were observed to have developed MCI. Among the participants who did not exhibit MCI at baseline, the incidence rate was 10.5 per 100 person-years. Male sex and lack of engagement in mental activities were predictors of MCI among participants without MCI at baseline., Conclusion: After the 1½-year follow-up, the incidence rate for MCI was considerably high among the respondents. Being male and being less engaged in mental activities were predictors of the occurrence of MCI. Mental activities need to be promoted for the prevention of MCI incidence among older adults.

Objectives: The current study set out to examine the links between contact frequency with one's social network and cognitive health in later life. It assessed both direct and indirect pathways and the possible role of ethnicity in the effect of the social network on cognitive function. Method: We used data from adults aged 50 and above, which was collected in Israel as part of the Survey of Ageing, Retirement and Health (SHARE). A moderated mediation analysis was conducted to test the direct and indirect associations between contact frequency and cognitive function, as well as the moderation of these associations by population group. Three population groups were examined - veteran-Jews, Arabs and immigrants from the former Soviet Union. Results: Contact frequency with the close social milieu was found to be directly positively related to cognitive function. The association was also mediated by depressive symptoms, such that frequent contacts were linked to cognitive health via reduced depressive symptoms. This indirect link differed, however, among the three population groups. Conclusion: Contact frequency is important for cognitive health in the second half of life, and it operates both directly and by decreasing depressive symptoms. However, these links are not found among all ethnic groups and may, therefore, depend on the culture and social norms of each group and the meaning attributed to social ties.

Background/objectives: Limited research is available on the relationship between oral health symptoms and cognitive function among community-dwelling US Chinese older adults. The purpose of this study was to examine the associations between tooth/gum symptoms and changes in cognitive function., Design: Two-wave epidemiological study., Setting: Population Study of Chinese Elderly in Chicago (PINE)., Participants: US Chinese older adults (N = 2713; mean age = 72.6 y; 58.4% women)., Measurements: We selected self-reported oral (tooth and gum) symptoms as independent variables. To examine changes in cognitive function (wave 2: Baseline), we chose the following three domains: episodic memory (East Boston Memory Test); executive function (Symbol Digit Modalities Test); and working memory (Digit Span Backwards). In addition, we assessed global cognitive function by constructing a composite measure., Results: At baseline, 1297 participants (47.8%) reported having teeth symptoms, and 513 participants (18.9%) reported having gum symptoms. Adjusting for sociodemographic and health-related characteristics, participants who reported having teeth symptoms at baseline experienced their global cognition decrease by 0.07 units (estimate = -0.07; p = .003) and their episodic memory decrease by 0.07 units (estimate = -0.07; p = .026). Participants who reported having teeth symptoms at baseline experienced a faster rate of decline in global cognition for every additional year (estimate = 0.02; p = .047). However, this effect disappeared once we adjusted for all covariates (estimate = 0.02; p = .069). We found no significant relationship between baseline gum symptoms and change of cognitive function., Conclusion: Having teeth symptoms was associated with a decline in cognitive function among US Chinese older adults. Developing policy measures aimed at ameliorating health and improving cognition in this high-risk fast-growing population in the United States would need to include oral health preventive and dental care services. J Am Geriatr Soc 67:S532-S537, 2019., (© 2019 The American Geriatrics Society.)

This study examined multiple influences on cognitive function among African Americans, including education, literacy, poverty status, substance use, depressive symptoms, and cardiovascular disease (CVD) risk factors. Baseline data were analyzed from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Participants were 987 African Americans (mean age 48.5 years, SD = 9.17) who completed cognitive measures assessing verbal learning and memory, nonverbal memory, working memory, verbal fluency, perceptuo-motor speed, attention, and cognitive flexibility. Using preplanned hierarchical regression, cognitive performance was regressed on the following: (1) age, sex, education, poverty status; (2) literacy; (3) cigarette smoking, illicit substance use; (4) depressive symptoms; and (5) number of CVD risk factors. Results indicated that literacy eliminated the influence of education and poverty status in select instances, but added predictive utility in others. In fully adjusted models, results showed that literacy was the most important influence on cognitive performance across all cognitive domains (p < .001); however, education and poverty status were related to attention and cognitive flexibility. Depressive symptoms and substance use were significant predictors of multiple cognitive outcomes, and CVD risk factors were not associated with cognitive performance. Overall, findings underscore the need to develop cognitive supports for individuals with low literacy, educational attainment, and income, and the importance of treating depressive symptoms and thoroughly examining the role of substance use in this population.

Background: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups., Methods and Findings: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife., Conclusions: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: AEA is a consultant for Kinsa Inc. and has received an unrestricted gift from Gojo Inc. CB is a member of the Editorial Board of PLOS Medicine. HB is on the Advisory Board of Nutricia Australia. MG was on Biogen Inc’s “Patient Journey Advisory Group” in 2016 and 2017. NS reports personal fees from Merck Consumer Health and the NIH outside the submitted work. RBL is the Edwin S. Lowe Professor of Neurology at the Albert Einstein College of Medicine in New York. He receives research support from the NIH: 2PO1 AG003949 (mPI), 5U10 NS077308 (PI), RO1 NS082432 (Investigator), 1RF1 AG057531 (Site PI), RF1 AG054548 (Investigator), 1RO1 AG048642 (Investigator), R56 AG057548 (Investigator), K23 NS09610 (Mentor), K23AG049466 (Mentor), 1K01AG054700 (Mentor). He also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from: American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, Vedanta. He receives royalties from Wolff’s Headache 7th and 8th Edition, Oxford Press University, 2009, Wiley and Informa. PSS received grant funding from the NIH/NIA (USA) and the NHMRC (Australia), as well as philanthropic funding through The Dementia Momentum. He is on the Australian Advisory Board of Biogen Pharmaceuticals. All other authors have declared that no competing interests exist.

Background: Sugar is widely consumed in Malaysia, and the excessive intake of sugar has been associated with cognitive functions. However, the association between sugar intake and cognitive impairment among Malaysian older adults is yet to be determined. Purpose: The objective of this study was to evaluate the associations between types and sources of sugar intake and cognitive functions and to identify their risk in predicting cognitive impairment (MMSE score <24). Subjects and methods: A total of 1,209 subjects aged ≥60 years were recruited through multi-stage random sampling from selected states in Malaysia. Dietary intake was derived using a 7-day dietary history questionnaire and supplemented with a quantitative food frequency questionnaire for added sugar intake. Results: The prevalence of cognitive impairment as defined by Mini-Mental State Examination (MMSE) less than 24 was 31.9%, while the prevalence of mild cognitive impairment was 13.1%. The median (IQR) for total sugar intake was 44.60 g/day (26.21-68.81) or 8 tsp, and free sugar intake was 33.08 g/day (17.48-57.26) or 6 tsp. The higher intake of total sugars, free sugars, sucrose, lactose, sugar-sweetened beverages, sugar-sweetened cakes, and dessert was found to be significantly associated with a lower MMSE score, after adjusting for covariates. On the other hand, the consumption of cooked dishes and fruits was significantly associated with a better MMSE score. The adjusted OR for risk of cognitive impairment (MMSE score <24) was 3.30 (95% CI 2.15-5.08) for total sugars and 3.58 (95% CI 2.32-5.52) for free sugars, comparing the highest with the lowest intake percentiles. Conclusion: Excessive sugar consumption among older adults showed a notable association with poor cognitive functions, but longitudinal studies and clinical trials are further needed to clarify the direction of causality and to investigate the underlying mechanism., Competing Interests: The authors report no conflicts of interest in this work.

Objectives: The purpose of this review was to summarize the current status of knowledge regarding cognitive dysfunction and diabetes in minorities. Literature on the interaction of cognitive dysfunction and diabetes was analyzed to (a) examine the number and characteristics of studies in minority populations; (b) identify tests used to assess cognitive function in diabetes; (c) consider the impact of diabetes on cognitive function; and (d) assess the moderators of the association between diabetes and cognitive function., Design: A literature review and thematic analysis was conducted. Studies were mapped to describe their design, target population, instruments used, and the physiologic, psychosocial, and socioeconomic findings related to cognitive function and diabetes. Twelve studies met the inclusion criteria., Results: Hispanics were studied more than any other ethnic group. Rates and degree of cognitive dysfunction were more prevalent in minorities than non-Hispanic whites. Overall, 28 different tests were administered to evaluate cognitive function. There was some variation among findings regarding the relationship of cognitive function and diabetes. Risk for cognitive decline was associated with the diagnosis of diabetes alone, regardless of whether the diabetes was treated or untreated. Higher rates of discrimination were associated with greater cognitive decline Conclusion: Given the context of minority health, there is a potential for higher negative health impact due to the increased prevalence of diabetes and cognitive dysfunction and other related health disparities. Reduction of physiological risk factors for diabetes, consistency in assessment, as well as elimination of structural barriers such as access to care should be helpful in decreasing the incidence of both diabetes and cognitive decline. More research is needed to determine whether the observed differences are modifiable and to identify factors involved in the interaction of diabetes and cognitive decline-not only physiological factors, but factors related to socioeconomic status and quality of life.

Introduction: The Montreal Cognitive Assessment (MoCA) is a popular screening tool for Mild Cognitive Impairment (MCI). The psychometric properties of the MoCA have not been widely examined in minority groups. We aimed to analyze the discriminate ability of subtests and items by race and ethnicity given gold-standard clinical diagnosis of cognitive status., Methods: We analyzed data from the National Alzheimer Coordinating Center Uniform Data Set March 2018 data freeze. Stepwise regression was used to determine which subtests predicted cognitive status (normal cognition, MCI, or dementia), by race/ethnicity. Item discrimination and difficulty was calculated by race/ethnicity and cognitive status., Results: In our sample (n=3895), with an average age of 69.7, 80.7% were non-Hispanic white, 15.0% were non-Hispanic black, and 4.2% were Hispanic. Among non-Hispanic whites all subtests, education, and age predicted clinician diagnosis, while visuospatial/executive, attention, language, delayed recall, and orientation subtests were predictive among non-Hispanic blacks and visuospatial/executive, delayed recall, and orientation subtests and education were predictive among Hispanics. Item discrimination and difficulty varied by race/ethnicity and cognitive status., Conclusions: By understanding the psychometric properties of MoCA subtests, we can focus on subtests that have higher discrimination and more diagnostic utility. Subtests should be further evaluated for use in screening of minority individuals.

Purpose: To assess whether there are differences in Alzheimer disease (AD)-associated atrophy regions in Chinese and white patients with AD versus cognitively normal older adults, and to test whether associations between clinical severity and gray matter volume are similar or different across these ethnic groups in a cross-sectional analysis., Materials and Methods: Chinese and white patients with AD, individuals with mild cognitive impairment, and cognitively normal controls (46 white and 48 Chinese) were clinically evaluated at an academic center within 1 year of magnetic resonance imaging acquisition. Clinical severity was assessed using the Clinical Dementia Rating Sum of Boxes and cortical atrophy was measured using voxel-based morphometry as well as Freesurfer. Chinese and white cohorts were demographically matched for age, sex, and education., Results: Clinical severity by diagnosis was similar across ethnicities. Chinese and white patient groups showed similar amounts of atrophy in the regions most affected in AD after accounting for demographic variables and head size. There was no significant difference between ethnic groups when compared by atrophy and clinical severity., Conclusions: Our study suggests that Chinese and white patients with AD, when matched demographically, are clinically and neuroanatomically similar on normalized measures of cortical atrophy and clinical severity.

Among non-Hispanic whites, cardiovascular risk factors are associated with increased mortality and poorer cognition. Prevalence of cardiovascular risk factors among aging Hispanics is also high and Hispanics generally have poorer access to healthcare, yet they tend to have advantageous cardiovascular disease rates and outcomes and live longer than non-Hispanic whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. Although robust data support these ethnic benefits on physical health and mortality, it is unknown if it extends to include cognition resilience advantages in older adulthood. The present study compared relationships between cardiovascular risk and cognition (executive functions and episodic memory) in late middle age and older Hispanics ( n = 87) and non-Hispanic whites ( n = 81). Participants were selected from the National Alzheimer's Coordinating Center and Alzheimer's Disease Neuroimaging Initiative databases. Hispanics and non-Hispanic white groups were matched on age (50-94 yr, mean age = 72 yr), education, gender, cognitive status (i.e., cognitively healthy versus mildly cognitively impaired), and apolipoprotein E4 status. History of hypertension and higher body mass index were both associated with poorer executive functions among Hispanics but not non-Hispanic whites. Our findings suggest greater vulnerability to impairments in executive functions among Hispanics with hypertension and obesity, contrary to the notion of a Hispanic health paradox for cognitive aging., (© 2019 Stickel et al.; Published by Cold Spring Harbor Laboratory Press.)

The lived experiences of elderly dementia patients are affected by their cultural beliefs. This study aims to explore the lived experiences of elderly dementia patients in Taiwan in order to understand how they view their lives given the cognitive impairments that they suffer from. A descriptive phenomenological approach was undertaken in 12 elderly dementia patients who were selected using purposive sampling. Data were analysed using Colaizzi's analysis method. Five main themes emerged from the narratives: (i) distress caused by inability to remember; (ii) counteracting memory loss; (iii) worry about being a burden to family; (iv) cherishing the current situation and gaining respect; and (v) adopting a dispassionate view about life and death. The traditions of filial piety in Chinese culture were reflected in the experiences of these elderly dementia patients. Elderly dementia patients experienced inconveniences in their daily lives due to marked impairments in memory functions, and they even doubted their own independent capabilities. To counteract their disease, many elderly dementia patients developed self-contained approaches to handle their loss of memories. While they were worried about being a burden to their families, they also valued their current situation. They were comforted by being taken care of by their children, and they adopted a dispassionate view about life and death issues. For the care of elderly dementia patients, besides reducing the inconveniences brought about by cognitive impairments, there is also a need to pay attention to the deterioration of their physical bodily functions in order to intervene in their lives holistically., (© 2019 Australian College of Mental Health Nurses Inc.)

Objective: Examining cultural differences in assessment of cognitive/functional disability among older Americans is needed. This analysis examined associations between day-to-day function, measured by activities of daily living (ADL), and cognition, measured by CLOX scores, among older African American (AA) and non-Hispanic White (nHW) community-dwelling women and men., Methods: Design- Cross-sectional., Setting: Homes of community-dwelling older adults. Participants- 893 Medicare beneficiaries >65 living in west-central Alabama, without diagnoses of dementia, who were participants in the University of Alabama at Birmingham (UAB) Study of Aging, and who had complete data. Measurements- Physical function was assessed by self-reported ADL difficulty; cognitive function by CLOX, a clock drawing-task. Multivariable, linear regression models were used to examine associations within race/sex specific groups., Results: After controlling for socio-demographic factors and comorbidities, CLOX1 scores were inversely and significantly correlated with ADL for AA men (β = -0.205, P = 0.003). CLOX2 scores were similarly associated with ADL and IADL for the total group (β = -0.118, P = 0.001, and β = -0.180, P < 0.001, respectively); for ADL, significant associations were seen for AA men and nHW women (β = -0.203, P = 0.004, and β = -0.139, P = 0.02, respectively) and, for IADL, in AA women and men (β = -0.156, P = 0.03, and β = -0.24, P < 0.001, respectively)., Conclusion: While African American women reported the highest difficulty with ADLs and IADLs among all race/sex groups, CLOX1 scores were correlated with ADL for AA men only. CLOX1 may have limitations to identify functional disability for older AA women. [Word Count = 234]., (Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: Few empirical studies have examined strengths and support of older people in circumstances of precarity. A better understanding of this problem has the potential to contribute to the development of care planning and delivery., Purpose: To investigate how older people deal with episodes of precarity in South Louisiana., Method: More than 300 hr of participant observation and interviews were conducted with 20 predominantly older African American women in a housing complex for low-income older persons and two senior citizen centres., Results: The findings demonstrate five central negative conditions of precarity that older people had to manage: (a) loss and discontinuity of home-based healthcare services, (b) stress after loss or disruption of social support, (c) problems of poverty, (d) cognitive impairment and declining health and (e) stress of eviction. Strengths and support that older people used were as follows: (a) spiritual faith, (b) psychological strengths, (c) spiritual relationships, (d) family support, (e) friendships of love and friendships of helpfulness, (f) care and support performed by home-based services, (g) senior centre and housing complex activities, (h) church memberships and activities, and (i) grocery store and café contacts., Conclusion: Home-based services were not sufficient to prevent and reduce precarity for older people because of a lack of and discontinuities in these services., Implications for Practice: This study adds to the literature about precarity among community-based older people by demonstrating gaps in care support and medication access. The findings suggest that ongoing state funding and support by home-based services are necessary to support frail older people in precarious living conditions to survive and handle stressful life events by reducing vulnerability and enhancing strengths and supportive resources of older people., (© 2019 John Wiley & Sons Ltd.)

Background: Despite its important role in cognitive development and regulation of nervous system function, vitamin B-6 has been under-studied in relation to cognitive aging., Objective: We investigated whether plasma pyridoxal-5'-phosphate (PLP, vitamin B-6) concentrations were associated with cognitive function and subsequent cognitive decline., Methods: In a longitudinal study of 949 participants (aged 45-75 y at baseline; 70% women) from the Boston Puerto Rican Health Study cohort, we examined the association between baseline plasma PLP and baseline cognitive function and 2-y cognitive decline. Cognitive function was assessed with an in-person 7-test cognitive battery, at baseline and 2-y follow-up. We also used logistic regression to estimate the odds of major 2-y decline in global cognitive function (defined as decline ≥1 SD below the mean), as well as decline in executive function and memory. We also used multivariable linear regression to calculate adjusted mean differences in cognitive scores, and 95% CIs, across tertiles of plasma PLP at baseline, as well as cross-sectional and longitudinal associations with individual test scores., Results: In analyses adjusted for potential confounders, the OR of having a major 2-y decline in global cognitive function was 2.46 (95% CI: 1.49, 4.05; P-trend: 0.001) among participants in the lowest tertile of PLP compared with those in the top tertile of PLP. The association of PLP with cognition was stronger in participants older than 55 y at baseline (OR for bottom to top tertile: 4.58; 95% CI: 2.02, 10.35; P-interaction: 0.01) compared with those 55 y old or younger, as well as in ever smokers (OR for bottom to top tertile: 2.99; 95% CI: 1.45, 6.19; P-interaction: 0.02) compared with never smokers., Conclusions: Lower baseline plasma PLP was associated with increased odds of 2-y cognitive decline in a cohort of Boston area Puerto Ricans. The association was stronger among older participants and among ever smokers., (Copyright © American Society for Nutrition 2019.)

ABSTRACTObjectives:This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans., Methods: Data from a pilot study at the Mount Sinai Alzheimer's Disease Research Center was examined. All participants were &gt; 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer's disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA)., Results: The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups., Conclusions: This study highlights the need for cognitive assessment in elderly Chinese immigrants.

Mitochondrial function has been implicated and studied in numerous complex age-related diseases. Understanding the potential role of mitochondria in disease pathophysiology is of importance due to the rise in prevalence of complex age-related diseases, such as type 2 diabetes (T2D) and Alzheimer's disease (AD). These two diseases specifically share common pathophysiological characteristics which potentially point to a common root cause or factors for disease exacerbation. Studying the shared phenomena in Mexican Americans is of particular importance due to the disproportionate prevalence of both T2D and AD in this population. Here, we assessed the potential role of mitochondria in T2D and cognitive impairment (CI) in a Mexican American cohort by analyzing blood-based indices of mitochondrial DNA copy number (mtDNACN) and cell-free mitochondrial DNA (CFmtDNA). These mitochondrial metrics were also analyzed for correlation with relevant neuropsychological variables and physiological data collected as indicators of disease and/or disease progression. We found mtDNACN to be significantly decreased in individuals with CI, while CFmtDNA was significantly elevated in T2D; further, CFmtDNA elevation was significantly exacerbated in individuals with both diseases. MtDNACN was found to negatively correlate with age and fatty acid binding protein concentration, while positively correlating with CFmtDNA as well as CERAD total recall score. Candidate gene SNP-set analysis was performed on genes previously implicated in maintenance and control of mitochondrial dynamics to determine if nuclear variants may account for variability in mtDNACN. The results point to a single significant locus, in the LRRK2/MUC19 region, encoding leucine rich repeat kinase 2 and mucin 19. This locus has been previously implicated in Parkinson's disease, among others; rs7302859 was the driver SNP. These combined findings further indicate that mitochondrial dysfunction (as assessed by proxy via mtDNACN) is intimately linked to both T2D and CI phenotypes as well as aging., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Although cognitive impairment is common among patients with chronic heart failure (HF), the accuracy with which caregivers can recognize it is unknown. This study aimed to examine the degree to which subjective and objective evaluations coincide., Methods: Cognitive function was evaluated subjectively and objectively in 184 hospitalized patients aged 65 or older (82 ± 7.2 years old and 49% male) with HF, who were divided into three groups: (i) normal; (ii) mild cognitive impairment; and (iii) severe cognitive impairment., Results: The intrapatient agreement of the results of subjective and objective evaluations was tested, and weighted κ coefficients showed poor agreement (0.54, 95% confidence interval: 0.42-0.66, P < 0.001)., Conclusion: Subjective and objective cognitive function evaluations in older patients with HF are poorly concordant., (© 2018 AJA Inc.)

Mistreatment is an important social outcome of the growing cognitive impairment epidemic, particularly in developing countries. This study aimed to bring to light what is known about mistreatment in cognitively impaired individuals in Latin American Countries. We identified a gap in the literature on this topic that opens the door for future research.

Objectives: This study examined the longitudinal relationship between dietary habits and cognitive impairment among the oldest-old Chinese., Method: Cognitively intact adults aged 80 or older (N = 4,749) came from the Chinese Longitudinal Healthy Longevity Survey. Cognitive impairment was assessed by Mini-mental State Examination. Cox regressions were performed to examine the relationship between dietary habits and cognitive impairment onset during follow-up period of 1998-2012, adjusting for various time-variant and time-invariant individual characteristics., Results: Compared with those who rarely/never consumed fruit, vegetables, meat, and soybean-derived products, participants consuming such products almost every day were 21%, 25%, 17%, and 20% less likely to develop cognitive impairment during follow-up, respectively. Compared with those who rarely/never consumed sugar, participants consuming sugar almost every day were 17% more likely to develop cognitive impairment during follow-up. Consumption of fish, egg, salt-preserved vegetable, tea, and garlic was not found to be associated with cognitive impairment., Discussion: Dietary habits might profoundly impact cognitive functioning among the oldest-old Chinese. This work has limitations pertaining to study design and measure. Future work adopting experimental design and refined dietary measures is warranted to confirm these findings and inform public nutrition practices aiming at preventing cognitive decline among the oldest-old Chinese population., (© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

As data on prevalence and etiology of dementia in American Indians are limited, we sought to determine rates and patterns of memory loss among American Indian veterans with vascular risk factors. Sixty consecutive outpatient American Indian veterans with a mean age of 64 years (range 50-86), without prior dementia or mild cognitive impairment (MCI), and with ≥ 2 vascular risk factors were enrolled. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores < 26 were referred for additional evaluation, including imaging, serology, and neuropsychological testing. Overall rates, types, and distribution of cognitive impairment were determined. Most prevalent vascular risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and smoking (78%). Eight patients (13%) with severe depression were excluded, leaving 23/52 with abnormal MoCA scores (44%, 95%CI 30%-59%). Fifteen completed additional evaluation for memory loss, including four with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). These results show that rates of undiagnosed cognitive impairment among American Indian veterans with vascular risk factors exceed rates previously published in non-American Indian cohorts. The most common etiology is vascular. Our findings support the need to improve vascular risk reduction in this understudied population.

Although the association between high blood pressure (BP), particularly in midlife, and late-life dementia is known, less is known about variations by race and sex. In a prospective national study of 22 164 blacks and whites ≥45 years without baseline cognitive impairment or stroke from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke), enrolled 2003 to 2007 and followed through September 2015, we measured changes in cognition associated with baseline systolic and diastolic BP (SBP and DBP), as well as pulse pressure (PP) and mean arterial pressure, and we tested whether age, race, and sex modified the effects. Outcomes were global cognition (Six-Item Screener; primary outcome), new learning (Word List Learning), verbal memory (Word List Delayed Recall), and executive function (Animal Fluency Test). Median follow-up was 8.1 years. Significantly faster declines in global cognition were associated with higher SBP, lower DBP, and higher PP with increasing age ( P<0.001 for age×SBP×follow-up-time, age×DBP×follow-up-time, and age×PP×follow-up-time interaction). Declines in global cognition were not associated with mean arterial pressure after adjusting for PP. Blacks, compared with whites, had faster declines in global cognition associated with SBP ( P=0.02) and mean arterial pressure ( P=0.04). Men, compared with women, had faster declines in new learning associated with SBP ( P=0.04). BP was not associated with decline of verbal memory and executive function, after controlling for the effect of age on cognitive trajectories. Significantly faster declines in global cognition over 8 years were associated with higher SBP, lower DBP, and higher PP with increasing age. SBP-related cognitive declines were greater in blacks and men.

The purpose of this study was to explore racial/ethnic differences in midlife women's cognitive symptoms among four major racial/ethnic groups in the United States and to determine multiple factors that influenced the women's cognitive symptoms. This was a secondary analysis of the data from two larger studies among 1,054 midlife women. The instruments included multiple questions on background characteristics and health and menopausal status, and the Cognitive Symptom Index for Midlife Women. The data were analyzed using multiple logistic and Poisson regression analyses. There existed significant racial/ethnic differences in the total numbers and total severity scores of cognitive symptoms ( p < .01); non-Hispanic Asians had significantly lower total numbers and total severity scores compared with other racial/ethnic groups. Socioeconomic status and health and menopausal status were significant factors that influenced cognitive symptoms across racial/ethnic groups ( p < .05). Further studies on racial/ethnic differences in cognitive symptoms are needed with diverse groups of midlife women.

Neuropsychiatric symptoms are common in patients with Parkinson's disease (PD) and they are likely to outweigh the motor symptoms and become a major factor affecting the quality of life of PD patients. However, the studies focusing on the non-motor symptoms in Chinese PD patients from different ethnicity are scarce. The aim of this retrospective study was to investigate neuropsychiatric symptoms and cognitive impairment in Chinese PD patients from Han and Hui populations from central China. Seventy-two Han Chinese PD patients (Han PD group) and 71 age-and sex-matched Hui Chinese PD patients (Hui PD group) were enrolled from Zhongnan Hospital of Wuhan University between Sept. 2011 and Aug. 2014 in the study. The neuropsychiatric symptoms and cognitive impairment were assessed using Neuropsychiatric Inventory (NPI) and Mini Mental State Examination (MMSE). We found that the proportion of depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were higher in the Han PD group than in the Hui PD group (P<0.05 or P<0.01). But the proportion of delusion, hallucination, agitation, disinhibition, aberrant motor behavior and change in appetite were not significantly different between the Han PD group and the Hui PD group (P>0.05). The total mean scores of the MMSE from patients in the Han PD group were similar to those in the Hui PD group (P>0.05). However, the subscale scores of recall domain and language domain in the Han PD group were significantly different from those in the Hui PD group (P<0.05). No significant difference was noted in the orientation, memory and calculation domains between the two PD groups (P>0.05). This study first showed the recall domain and language domain were different between the Han PD patients and the Hui PD patients. Depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were less presented in the Hui PD patients. All these differences may be related to the different ethnicity, which would be helpful for clinical physicians to recognize the different non-motor symptoms in Chinese PD patients with different ethnicity.

Background: Cognitive impairment (CI) is estimated to be present in 25%-80% of heart failure (HF) patients, but its prevalence at diagnosis is unclear. To improve our understanding of cognition in HF, we determined the prevalence of CI among adults with incident HF in the REGARDS study., Methods and Results: REGARDS is a longitudinal cohort study of adults ≥45 years of age recruited in the years 2003-2007. Incident HF was expert adjudicated. Cognitive function was assessed with the Six-Item Screener. The prevalence of CI among those with incident HF was compared with the prevalence of CI among an age-, sex-, and race-matched cohort without HF. The 436 participants with incident HF had a mean age of 70.3 years (SD 8.9), 47% were female, and 39% were black. Old age, black race, female sex, less education, and anticoagulation use were associated with CI. The prevalence of CI among participants with incident HF (14.9% [95% CI 11.7%-18.6%]) was similar to the non-HF matched cohort (13.4% [11.6%-15.4%]; P < .43)., Conclusions: A total of 14.9% of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. Increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The threshold for amyloid positivity by visual assessment on PET has been validated by comparison to amyloid load measured histopathologically and biochemically at post mortem. As such, it is now feasible to use qualitative visual assessment of amyloid positivity as an in-vivo gold standard to determine those factors which can modify the quantitative threshold for amyloid positivity. We calculated quantitative amyloid load, measured as Standardized Uptake Value Ratios (SUVRs) using [18-F]florbetaben PET scans, for 159 Hispanic and non-Hispanic participants, who had been classified clinically as Cognitively Normal (CN), Mild Cognitive Impairment (MCI) or Dementia (DEM). PET scans were visually rated as amyloid positive (A+) or negative (A-), and these judgments were used as the gold standard with which to determine (using ROC analyses) the SUVR threshold for amyloid positivity considering factors such as age, ethnicity (Hispanic versus non-Hispanic), gender, cognitive status, and apolipoprotein E ε4 carrier status. Visually rated scans were A+ for 11% of CN, 39.0% of MCI and 70% of DEM participants. The optimal SUVR threshold for A+ among all participants was 1.42 (sensitivity = 94%; specificity = 92.5%), but this quantitative threshold was higher among E4 carriers (SUVR = 1.52) than non-carriers (SUVR = 1.31). While mean SUVRs did not differ between Hispanic and non-Hispanic participants;, a statistically significant interaction term indicated that the effect of E4 carrier status on amyloid load was greater among non-Hispanics than Hispanics. Visual assessment, as the gold standard for A+, facilitates determination of the effects of various factors on quantitative thresholds for amyloid positivity. A continuous relationship was found between amyloid load and global cognitive scores, suggesting that any calculated threshold for the whole group, or a subgroup, is artefactual and that the lowest calculated threshold may be optimal for the purposes of early diagnosis and intervention., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Dementia is the leading cause of dependency and disability among older persons worldwide. There remains, however, limited studies on dementia rates within the Asia-Pacific region, with little data on differences across major Asian ethnic groups., Objective: To study the prevalence of cognitive impairment (CI) and dementia in community-dwelling Indians from Singapore and to examine interethnic differences among Chinese, Malays, and Indians., Methods: Participants (>60 years) drawn from the Indian component of the multiethnic Epidemiology of Dementia in Singapore (EDIS) study were screened using the locally validated Abbreviated Mental Test and Progressive Forgetfulness Questionnaire. Screen-positive participants underwent further detailed neuropsychological assessments. CI was classified into Cognitive impairment no dementia (CIND)-mild, CIND-moderate, and dementia., Results: Of 961 Indian adults, 120 (12.5%) had CIND-mild, 101 (10.5%) CIND-moderate, and 12 (1.2%) dementia. The overall age-standardized prevalence of any CI was 24.6%. The prevalence of any CI increased with age (15.7% in ages 60-64 years to 30.1% in ages≥80 years), and was higher in women than men. Multivariate analysis showed that age, lower education, and hypertension were independently associated with CI. Even after demographic and cardiovascular risk factor adjustment, Indians were more likely to be cognitively impaired compared to Chinese (odds ratio [OR], 95% CI:1.37 [1.01-1.86]) but not Malays (0.89 [0.72-1.10])., Conclusions: Among elderly Indians, the overall prevalence of any CI was 24.6%. Despite similar assessment protocols and risk factor adjustments, the prevalence of CI was higher in Indians compared to Chinese but similar to Malays. Further research is needed to unravel other factors that may underlie these ethnic differences.

Research suggests that the prevalence and incidence of cognitive impairment among older adults is decreasing. This analysis used data from 9 waves (1993-2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess cognitive status and cognitive decline for 2 cohorts of Mexican-Americans aged ≥75 years in 1993-1994 versus 2004-2005. Logistic regression, joint longitudinal survival models, and illness-death models for interval-censored data were used to examine cohort differences in the odds of prevalent cognitive impairment, trajectories of cognitive decline, and the risk of 10-year incident cognitive impairment, respectively. Results indicated that compared with the 1993-1994 cohort, the 2004-2005 cohort had higher odds for prevalent cognitive impairment (odds ratio = 2.51, 95% confidence interval (CI): 1.92, 3.29), particularly among participants with <4 years of education (odds ratio = 2.99, 95% CI: 2.14, 4.18). Conversely, the 2004-2005 cohort exhibited significantly slower rates of cognitive decline (βˆ = 0.50, 95% CI: 0.39, 0.62) and had a significantly lower risk of incident cognitive impairment (hazard ratio = 0.75, 95% CI: 0.62, 0.91) compared with the 1993-1994 cohort. This analysis provides mixed results for cohort trends in the cognitive health of older Mexican-Americans. Continued research is needed to identify risk factors that contribute to these population-level trends.

Background: Racial and ethnic minorities consistently demonstrate disparate post-stroke outcomes. However, there is a paucity of literature related to whether this disparity exists specifically in post-stroke cognitive decline., Objective: To determine if racial and ethnic disparities exist in post-stroke subjective cognitive decline (SCD) among non-Hispanic Blacks (Blacks), American Indians or Alaska Natives (AI/ANs), Hispanics, and non-Hispanic Whites (Whites) in the United States using data from the Behavioral Risk Factor Surveillance System (BRFSS)., Methods: A retrospective analysis was completed using the 2016 BRFSS data in adults who self-reported stroke and SCD. Descriptive statistics were completed for baseline comparisons using chi squared tests for categorical variables. A binary logistic regression controlling for baseline differences was completed to examine racial and ethnic differences in SCD., Results: Significant differences in SCD were identified across all racial and ethnic groups. When compared to Whites, Blacks, AI/ANs, and Hispanics more frequently reported worsening confusion or memory loss that interfered with day-to-day activities and the ability to work, volunteer, and engage in social activities outside of the home. AI/ANs who reported SCD were more likely than Whites to have help available. Hispanic persons with SCD or their family members were most likely to discuss SCD with a healthcare provider., Conclusion: Although persons from all racial and ethnic groups in this study experienced some degree of SCD, Blacks, AI/ANs, and Hispanics most frequently reported worsening confusion or memory loss impacting engagement in day-to-day activities and the ability to work, volunteer, and engage in social activities outside of the home., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Impaired neurocognitive function (NCF) is a well-established consequence of pediatric medulloblastoma (MB) and its treatments. However, the frequency and features of neurocognitive dysfunction in adult-onset MB patients are largely unknown., Methods: Adult patients (≥ 18 years) with MB who had received formal neurocognitive evaluation (N = 27) were identified. Demographic, medical, and treatment histories were extracted from the medical record. Lesion properties on MRI were analyzed and used to evaluate lesion-symptom mapping further. Demographically adjusted z-scores were calculated for each neurocognitive test and used to assess impairment frequency. Regression analyses were conducted to identify clinical and paraclinical factors associated with impaired NCF., Results: Mean age of the patient sample was 33 years (SD = 11) at the time of MB diagnosis. Prior therapy included surgical resection (89%), radiation (70%), and chemotherapy (26%). A significant proportion of patients were impaired on tests of verbal learning and memory (32%), executive function (29%), and naming (18%). Age, education, lesion size, time from surgery, and number of chemotherapy cycles had the greatest contribution to test performance in random-forest regression models., Conclusion: This study identifies frequent impairment of NCF in adult patients with MB, particularly in the domains of learning and memory and executive function. Neurocognitive impairment is influenced by patients' demographic, disease, and treatment history. Further study is warranted to characterize the clinical impact of adult MB more fully., (© 2018 John Wiley & Sons, Ltd.)

Background: Mexican Americans are at increased risk of developing mild cognitive impairment (MCI) and Alzheimer's disease compared to non-Hispanic whites. This study sought to examine the relationship between vascular risk, depression, and cognition in Mexican American elders., Methods: Data from 470 (390 normal controls, 80 MCI patients) Mexican Americans enrolled in the Health and Aging Brain among Latino Elders (HABLE) study were used. The cardiovascular risk was assessed by the Framingham Risk Score. Cognition was assessed with a neuropsychological battery, and depression was assessed based on scores from the Geriatric Depression Scale (GDS). ANOVAs were utilized to determine the differences in neuropsychological scores of normal controls with and without depression and CVD risk (low vs. high). Follow-up logistic regression was conducted to determine MCI risk., Results: The results of this study indicated that comorbid depression and a high CVD risk were associated with poorer cognitive performance in Mexican Americans. Depressed women with high CVD risk were more likely to have executive dysfunction, language deficits, and poorer global cognition than nondepressed women with a high CVD risk. In Mexican American men, those with a high vascular risk and depression were more likely to have executive dysfunction and poorer immediate memory than the nondepressed high-risk group. Higher GDS scores (OR = 1.10; 95% CI 1.02-1.10, p = 0.001) and higher vascular risk scores (OR = 1.05; 95% CI 1.02-1.10, p = 0.001) significantly predicted MCI status in Mexican Americans., Conclusion: The results of this study indicated that comorbid depression and a high CVD risk were associated with poorer cognitive performance and increased risk of MCI in Mexican Americans., (© 2018 S. Karger AG, Basel.)

Objectives: Multiple system atrophy (MSA) is a progressive neurodegenerative disorder that causes early sustained disability and poor health-related quality of life (HrQoL). The clinical features and their effects on the HrQoL of patients in China have received little attention in the research literature. We evaluated the clinical characteristics and HrQoL of Chinese patients with MSA., Materials and Methods: A total of 143 patients with MSA from the Department of Neurology, Shanghai Ruijin Hospital, were enrolled in the study from March 2014 to May 2017. Basic demographic data, motor symptoms, non-motor symptoms, and HrQoL were assessed and compared with data from 198 patients with idiopathic Parkinson's disease (PD) who were matched by age, gender, and disease duration. Factors influencing the HrQoL of MSA patients were also analyzed., Results: The ratio of patients with predominant parkinsonism (MSA-P) and prominent cerebellar ataxia (MSA-C) was 95:48 among the 143 MSA patients. MSA-P patients had a longer disease duration (p = 0.002), higher levodopa equivalent daily dose (p < 0.001), higher scores on the Unified Multiple System Atrophy Rating Scale (UMSARS) I (p = 0.026), UMSARS II (p < 0.001), UMSARS IV (p = 0.019), the Hamilton Rating Scale for Depression (p = 0.001), the Hamilton Anxiety Scale (p = 0.013), and lower scores on measures of olfaction (p = 0.021) and cognitive function (p = 0.044) than the MSA-C patients. Stepwise regression analysis showed that depression, anxiety, degree of disability, and disease severity were independent predictors of decreased HrQoL., Conclusions: The results indicate that MSA-P patients have more severe motor impairment, hyposmia, depression, anxiety, cognitive impairment, and lower HrQoL than MSA-C patients. Depression, anxiety, degree of disability, and disease severity are predictors of poor HrQoL among Chinese patients with MSA., (© 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Socioeconomic status and race/ethnicity are known to be associated with health disparities. This study used data (2010-2014) from the American Community Survey. Respondents over age 30 from Hawaii were included (n = 44,921). Outcome variables were self-reported disability in vision, hearing, ambulatory function, self-care, independent living, or cognitive function. Four measures of socioeconomic status were personal income, average income for the area, income inequality for area, and education. This study used multivariable logistic regression to predict disability by race/ethnicity and socioeconomic status, controlling for age and gender. All four measures of socioeconomic status were significant predictors of at least one type of disability after adjustment for age, gender, and other measures of socioeconomic status. Higher education was significantly related to having every type of disability. Similarly, people with high personal income were less likely to have each type of disability than those with middle income, and those with low income were more likely to have all disabilities except hearing. Income inequality was significantly associated with half the disabilities. Low area income was significantly associated with increased vision-related disability, while high income was associated with less likelihood of hearing-related disability. Native Hawaiians were significantly more likely to report having a disability than Filipinos and Chinese for all six types of disability, Japanese for four, and whites for two, after adjustment. These results suggest that in order to reduce health disparities for Native Hawaiians, as well as other ethnic groups, a range of socioeconomic factors need to be addressed.