B - 28 Health Literacy Is a Better Predictor of Neurocognitive Performance on Verbal Fluency Tasks than Race.

Abstract

Neuropsychologists have historically used demographically-adjusted normative data to account for race-associated differences in neurocognitive performance. Using race-based norms has become increasingly controversial, particularly following the National Football League 2014 concussion settlement, as such practices may perpetuate systemic inequities and biases. Adjusting for the effects of social determinants of brain health may be an alternative approach to race-based norms. A measurable social determinant of brain health that disproportionately affects Black, Indigenous, and People of Color (BIPOC) is health literacy, which has been well-associated with verbal fluency performance. The current study evaluated the incremental value of health literacy and race to predict neurocognitive performance on a verbal fluency measure. The sample comprised 71 BIPOC and 45 White participants (ages 18-87) who underwent an outpatient neuropsychological evaluation. Verbal fluency was measured via the F-A-S and Controlled Animal Word Association Test. Health literacy was measured via the Short Assessment of Health Literacy-English. Demographics included age, sex, race, and years of formal education. Race was categorized as White or BIPOC since binary classification is common in race-based norms. Hierarchical regression analysis revealed that the combination of race and health literacy have a significantly larger effect on verbal fluency performance than race alone (p < 0.001). Including this interaction in the model explained 13.07% more variance in neurocognitive performance than race as an independent predictor (R-squared increased from 4.83% to 17.90%). These findings suggest health literacy may be more helpful for accounting for group differences in neurocognitive performance than race when developing normative data.