A nuanced portrait of how race/ethnicity and nativity influence cognitive trajectories among older adults in the United States

Abstract

AbstractBackgroundCognitive decline and Alzheimer Disease and Related Dementias (ADRDs) represent significant public health challenges that affect the quality of life and independence of older adults. Previous research documents large racial/ethnic disparities in cognition; However, less is known about variation in cognitive functioning trajectories within minority populations, specifically among older Latinos. Understanding how demographic and socioeconomic factors influence cognitive health in later life is particularly important given the rapidly growing and diversifying United States population.MethodWe use 18‐years of biennial Health and Retirement Study data (1998‐2016) to estimate Generalized Estimating Equations (GEE) modeling sex specific age graded changes in global cognition and memory (based on Modified Telephone Interview for Cognitive Status) among White, Black, and U.S.‐ and foreign‐born Latino adults aged 51 years and older.ResultAdjusting for socioeconomic factors, health behaviors, and chronic health conditions, we find consistent evidence for curvilinear (quadratic) associations between age and cognitive change across race/ethnic and nativity groups (bage=028; SE=0.010; p<0.01 and bage2=‐0.005; SE<0.0001; pp<0.0001), regardless of sex. Among males, racial/ethnic and nativity differences in cognitive function were mainly evident at younger ages, particularly for Blacks compared to Whites (see Figure below). We found no evidence to support male racial/ethnic or nativity differentials in trajectories of cognitive aging. For women, older Black and US‐Born Latina adults, and to a lesser degree foreign‐born Latinas, had lower cognitive function at younger ages (see Figure). Moreover, White women showed more pronounced cognitive aging in comparison to U.S.‐ and foreign‐born Latinas (see Figure). These results were consistent for both global and memory specific outcomes.ConclusionOur findings support current calls for more nuanced considerations of racial/ethnic and nativity effects on cognitive aging and ADRDs. Understanding minority and immigrant differences in cognitive decline has implications for assessing the burden of cognitive disease and the development and implementation of culturally‐appropriate programs to promote healthy brain aging.