Layton Aging & Alzheimer Disease Center, Oregon Health and Science University, Portland.
Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada.
JAMA Netw Open. 2024 Sep 3;7(9):e2431180. doi: 10.1001/jamanetworkopen.2024.31180.
Determining the influence of race and ethnicity on change in cognitive test performance has significant implications for clinical practice and research in populations at risk for Alzheimer disease.
To evaluate the significance of race and ethnicity in predicting longitudinal cognitive test performance and to develop models to support evidence-based practice.
DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included baseline and 24-month follow-up data that were obtained from the Health and Aging Brain Study-Health Disparities (HABS-HD) study, an ongoing longitudinal observational study of aging and dementia in a multiracial, multiethnic cohort. Participants included community-dwelling adults and elders living in the Dallas and Fort Worth metropolitan area who were Hispanic and non-Hispanic adults older than the age of 50 years and were cognitively unimpaired.
The primary exposure of interest was time, measured in months.
Demographic variables included age, sex, education, and race and ethnicity. Cognitive domains included attention and working memory, processing speed, language, memory, and executive functioning. Linear regression models predicted follow-up performance from baseline performance and demographic variables for 13 commonly used neuropsychological tests. Follow-up testing was the primary outcome for all domains. Raw scores from 13 standardized tests were used for analyses.
This study included 799 adults who were cognitively unimpaired (352 Hispanic individuals [44.1%]; 447 non-Hispanic individuals [55.9%]; 524 female [65.6%]; mean [SD] age, 65.4 [8.1] years). In the regression models, all 13 follow-up scores were significantly predicted from their respective baseline scores and demographic variables. Baseline performance and education were the most consistent predictors of follow-up scores, contributing to all 13 models. Age was significantly associated with follow-up in 11 models, and sex was significant in 5 models. Race and ethnicity contributed to 10 of 13 models, with Hispanic participants predicted to have poorer follow-up scores than their non-Hispanic White counterparts on each test.
In this longitudinal study of cognitive change in Hispanic and non-Hispanic older adults who were cognitively unimpaired, standardized regression-based models were influenced by multiple demographic variables, including race and ethnicity. These findings highlight the importance of including race and ethnicity in such cognitive change models. This ability to accurately predict cognitive change is expected to become increasingly important as clinical practice and clinical trials need to become more diverse and culturally appropriate in this burgeoning global medical and societal crisis.
确定种族和民族对认知测试表现变化的影响，对于处于阿尔茨海默病风险中的人群的临床实践和研究具有重要意义。
评估种族和民族在预测纵向认知测试表现方面的重要性，并制定支持循证实践的模型。
设计、设置和参与者：这是一项预后研究，纳入了基线和 24 个月随访数据，这些数据来自正在进行的多种族、多种族老龄化和痴呆纵向观察研究——健康与老龄化大脑研究-健康差异（HABS-HD）研究。参与者包括居住在达拉斯和沃思堡大都市区的社区居住的成年人和老年人，他们是年龄在 50 岁以上的西班牙裔和非西班牙裔成年人，认知能力正常。
主要感兴趣的暴露因素是时间，以月为单位进行测量。
人口统计学变量包括年龄、性别、教育程度以及种族和民族。认知领域包括注意力和工作记忆、处理速度、语言、记忆和执行功能。线性回归模型根据基线表现和人口统计学变量预测 13 项常用神经心理学测试的随访表现。随访测试是所有领域的主要结果。对 13 项标准化测试的原始分数进行了分析。
本研究纳入了 799 名认知正常的成年人（352 名西班牙裔个体[44.1%]；447 名非西班牙裔个体[55.9%]；524 名女性[65.6%]；平均[标准差]年龄 65.4[8.1]岁）。在回归模型中，所有 13 项随访评分均显著来自各自的基线评分和人口统计学变量。基线表现和教育程度是预测随访评分最一致的因素，对所有 13 个模型均有贡献。年龄与 11 个模型显著相关，性别与 5 个模型显著相关。种族和民族对 10 个模型有影响，与非西班牙裔白人相比，西班牙裔参与者在每项测试中的随访评分都较差。
在这项对认知正常的西班牙裔和非西班牙裔老年人认知变化的纵向研究中，基于标准化回归的模型受到多种人口统计学变量的影响，包括种族和民族。这些发现强调了在这种认知变化模型中纳入种族和民族的重要性。随着临床实践和临床试验在这个快速发展的全球医学和社会危机中需要变得更加多样化和文化上合适，这种准确预测认知变化的能力预计将变得越来越重要。
