Discrimination Plays Role In Late-Life Cognitive Inequalities

Kristen George, PhD, MPH

Using a cohort of adults older than 90 years who were followed for incident dementia, findings from the LifeAfter90 (LA90) study suggested inequalities in cognition persist after accounting for experiences of lifetime discrimination. Presented at the 2022 Alzheimer’s Association International Conference (AAIC), July 31 to August 3, in San Diego, California, the study investigators noted that experiences of discrimination have an “indelible” association with cognitive health.¹

The study included 445 participants of either Asian (n = 88), Black (n = 97), Latino (n = 63), White (n = 162) or multirace (n = 35) backgrounds to understand the impact of major lifetime discrimination on cognitive function and decline, and whether longevity into old ages indicates overcoming discriminatory experiences. Presenting investigator Kristen George, PhD, MPH, postdoctoral scholar, University of California, Davis, and colleagues conducted a latent class analysis that categorized individuals into 3 groups based on responses to the 10-item Major Experiences of Discrimination Scale, gender, and race/ethnicity.

Class 1 (n = 51) consisted of mostly White men who reported workplace discrimination and had an average of 2 major discrimination experiences, while Class 2 (n = 342), known as the reference group, included White women and non-White participants who reported little/no discrimination averaging 0 experiences. Class 3 (n = 52) included all non-White participants who reported a mean of 4 discrimination experiences.

Executive function, verbal episodic memory, and semantic memory were assessed every 6 months with the Spanish and English Neuropsychological Assessment Scales and scores were z-standardized to baseline. Additionally, linear mixed models were used to assess the associations between classes of discrimination with cognitive change, all while adjusting for age, education, cognitive status, practice effects, follow-up time, and class time interactions.

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As compared with Class 2, those in Class 1 at baseline had significantly better executive function (ß: 0.28; 95% CI, 0.03-0.52), while no differences were found between Class 1 and Class 3. Baseline semantic memory was significantly better for Class 1 (ß: 0.33; 95% CI, 0.07-0.58) and significantly worse for Class 3 (ß: –0.24; 95% CI, -0.48 to 0.00) compared with Class 2. Across all 3 classes, no differences were observed for verbal episodic memory. Additionally, all classes demonstrated cognitive decline in all domains (ß range: –0.31 to –0.46), but the rate of change did not differ significantly by latent class.

It has been previously reported that discrimination may act as a barrier to care for patients with Alzheimer disease (AD). In the 2021 Facts and Figures report from the Alzheimer’s Association, survey results showed that 36% of Black Americans, 18% of Hispanic Americans, and 19% of Asian Americans felt that discrimination put a barrier on their access to receive care for their condition. In total, 42% of Native Americans, 34% of Asian Americans, and 33% of Hispanic Americans reported having experienced discrimination when navigating health care settings for their care recipient.²

In the video below, Carl V. Hill, PhD, MPH, chief diversity, equity, and inclusion officer, Alzheimer’s Association, provided insight on the report’s findings and ways that physicians can get involved in a conversation with NeurologyLive^® at the time of the report’s publication.

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REFERENCES
1. George K, et al. Experiences of discrimination on cognitive function and aging among the oldest old. Presented at: 2022 Alzheimer’ Association International Conference; July 31-Aug 3. Poster ID 67244
2. Alzheimer’s Association. 2021 Alzheimer’s Disease Facts and Figures Special Report: Race, Ethnicity and Alzheimer's in America. March 2, 2021. Accessed July 28, 2022. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf