Using a cohort of adults over the age of 90 who were followed for incident dementia, results from the LifeAfter90 (LA90) study suggest that cognitive inequalities persist after controlling for experiences of discrimination during life. life. Presented at the 2022 Alzheimer’s Association International Conference (AAIC), July 31-August 3, in San Diego, Calif., study researchers noted that experiences of discrimination have an “indelible” association with cognitive health.1

The study included 445 participants of Asian (n=88), black (n=97), Latino (n=63), white (n=162), or multiracial (n=35) backgrounds to understand the impact of lifelong major discrimination on cognitive function and decline, and whether longevity to old age indicates overcoming of discriminatory experiences. Presenting Investigator Kristen George, PhD, MPH, Postdoctoral Fellow, University of California, Davis, and colleagues conducted a latent class analysis that categorized individuals into 3 groups based on responses to the major experiences scale of 10 point discrimination, gender and race/ethnicity.

Class 1 (n=51) was comprised primarily of white males who reported workplace discrimination and had an average of 2 experiences of major discrimination, while Class 2 (n=342), known as the baseline, included white women and non-white participants who reported little or no discrimination with an average of 0 experiences. Class 3 (n=52) included all non-white participants who reported an average of 4 experiences of discrimination.

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

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Compared to class 2, those in class 1 at baseline had significantly better executive function (ß: 0.28; 95% CI, 0.03-0.52), while no difference was 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 to Class 2. In the 3 classes, no difference was observed for verbal episodic memory. Additionally, all classes demonstrated cognitive decline in all domains (β range: -0.31 to -0.46), but the rate of change did not differ significantly by latent class.

It has previously been reported that discrimination can act as a barrier to care for patients with Alzheimer’s disease (AD). In the Alzheimer’s Association’s 2021 Facts and Figures report, survey results showed that 36% of Black Americans, 18% of Hispanic Americans, and 19% of Asian Americans believed discrimination was a barrier. their access to care for their condition. A total of 42% of Native Americans, 34% of Asian Americans, and 33% of Hispanic Americans said they had experienced discrimination when navigating health care facilities for their care recipient.2

In the video below, Carl V. Hill, PhD, MPH, Director of Diversity, Equity and Inclusion, Alzheimer’s Association, provided an overview of the report’s findings and ways physicians can s engage in a conversation with NeurologyLive® at the time of publication of the report.

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REFERENCES
1. George K, et al. Discrimination experiments on cognitive functions and aging in older people. Presented at: 2022 Alzheimer’ Association International Conference; July 31-August 3. Poster ID 67244
2. Alzheimer Association. Alzheimer’s Disease Facts and Figures 2021 Special Report: Race, Ethnicity and Alzheimer’s Disease in America. March 2, 2021. Accessed July 28, 2022. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf