Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2021 Apr;69(4):1019-1026. doi: 10.1111/jgs.16986. Epub 2021 Jan 5.
BACKGROUND/OBJECTIVES: Trauma survivors with chronic post-traumatic stress disorder (PTSD) have been found to have cognitive impairment. But little is known about these outcomes among Latino and Asians who comprise more than 80% of the U.S. immigrant population. They also experience disparities in PTSD and dementia care albeit increased exposure to trauma. This study aimed to (1) examine the association between trauma exposures and PTSD with cognitive impairment in a sample of Latino and Asian older adults; and (2) assess whether sleep quality attenuated the PTSD-cognitive impairment association.
Cross-sectional secondary analysis of baseline data from the Positive Minds-Strong Bodies randomized controlled trial on disability prevention.
Community-based organizations serving minority or immigrant older adults in Massachusetts, New York, Florida, or Puerto Rico.
Hispanic/Latino and Asian/Pacific Islander adults aged 60 or older eligible per randomized controlled trial screening for elevated mood symptoms and minor-to-moderate physical dysfunction (n = 134 and n = 86, respectively).
Neuropsychiatric measures were cognitive impairment (Mini Montreal Cognitive Assessment (MoCA)), PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5), trauma exposure (Brief Trauma Questionnaire), depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder Scale-7), and daytime sleepiness (Epworth Sleepiness Scale).
Mean age was 72.8 years and 77.5 years for the Latino and Asian groups, respectively. The Asian group was 100% immigrant, whereas 70.2% (n = 92) of the Latino group was foreign-born. In unadjusted models, higher Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5 scores were associated with decreased odds of normal cognitive functioning (MoCA ≥25) in the Asian group (odds ratio (95% confidence interval) = .93 (.87, .99)), but not the Latino group (odds ratio (95% confidence interval) = .99 (.95, 1.05)). This association remained significant after adjusting for covariates. Daytime sleepiness did not moderate the association between PTSD and cognitive functioning in the Asian group.
Higher PTSD symptoms were associated with cognitive impairment in Asian, but not Latino, older adults. Clinicians serving older Asians should integrate trauma and cognitive screening to ensure this growing, underserved population receives appropriate evidence-based treatments.
背景/目的：患有慢性创伤后应激障碍（PTSD）的创伤幸存者已被发现存在认知障碍。但在美国移民人口中占 80%以上的拉丁裔和亚洲人，关于他们的这些结果却鲜为人知。尽管他们遭受了更多的创伤，但他们在 PTSD 和痴呆症护理方面也存在差异。本研究旨在：（1）在拉丁裔和亚裔老年人群体中，研究创伤暴露和 PTSD 与认知障碍之间的关系；（2）评估睡眠质量是否减弱了 PTSD 与认知障碍的关联。
对预防残疾的积极思维-强壮身体随机对照试验的基线数据进行横断面二次分析。
在马萨诸塞州、纽约州、佛罗里达州或波多黎各为少数族裔或移民老年人服务的社区组织。
符合随机对照试验筛查标准的 60 岁或以上的西班牙裔/拉丁裔和亚洲/太平洋岛民成年人，标准为情绪升高症状和轻度至中度身体功能障碍（分别为 134 人和 86 人）。
神经精神病学测量包括认知障碍（蒙特利尔认知评估量表（MoCA））、创伤后应激障碍（创伤后应激障碍检查表-5）、创伤暴露（简短创伤问卷）、抑郁（患者健康问卷-9）、广泛性焦虑（广泛性焦虑障碍量表-7）和白天嗜睡（艾普沃斯嗜睡量表）。
拉丁裔组和亚洲组的平均年龄分别为 72.8 岁和 77.5 岁。亚洲组全部为移民，而拉丁裔组中有 70.2%（n = 92）是外国出生。在未调整的模型中，较高的创伤后应激障碍检查表-5 评分与亚洲组正常认知功能（MoCA≥25）的可能性降低相关（比值比（95%置信区间）=0.93（0.87, 0.99）），但与拉丁裔组无关（比值比（95%置信区间）=0.99（0.95, 1.05））。在调整了协变量后，这种关联仍然显著。白天嗜睡并不能调节 PTSD 与亚洲组认知功能之间的关联。
较高的 PTSD 症状与亚洲老年人群体的认知障碍有关，但与拉丁裔老年人群体无关。为老年亚洲人服务的临床医生应整合创伤和认知筛查，以确保这一不断增长的、服务不足的人群得到适当的循证治疗。
