Characterization of subjective cognitive concerns (SCC) in a racially/ethnically diverse community‐based elderly cohort: Results from the Einstein Aging Study (EAS)

Abstract

AbstractBackgroundSCC may play an important role in identification of pre‐clinical dementia, especially among individuals who experienced disparities. A small number of studies examined the differential prediction of objective cognitive decline between blacks and whites using SCC, yielding mixed results. It is important to identify any differential patterns of SCC endorsement among racially diverse groups to enhance the ability to capture current and future cognitive status.MethodUsing data from the EAS, a longitudinal community residing cohort aged 70+, an SCC composite was derived using 22 self‐reported items. Cognitive status was diagnosed by consensus conference (dementia, MCI, cognitively normal). Objective cognition was measured using 3 factor scores (memory, executive function, global/verbal) derived from a principal component analysis of our neuropsychological battery. Multiple linear regression models were used to evaluate racial differences in SCC at baseline for those who were cognitively normal, as well as to determine whether there was a differential association between SCC and objective cognition among racial groups. Cox models were applied to determine if there was racial heterogeneity for the effect of SCC on incident MCI, adjusting for demographics, estimated premorbid intelligence, medical co‐morbidities, and depressive symptoms.Result1720 participants of non‐Hispanic white or black race were cognitively normal at baseline and included in these analyses. There was no significant difference between blacks and whites on the SCC composite; however, there was a significant interaction between race and SCC on 2 of 3 objective cognition factors. Having more SCC at baseline was associated with worse objective cognitive performance in the memory and global/verbal domains in white and black participants, but the association was significantly weaker among blacks. While SCC was associated with greater risk of incident MCI (<0.0001), there was no significant interaction between race and SCC on incident MCI.ConclusionDespite having weaker, though still significant, associations with memory and global/verbal tasks in blacks compared to whites, SCC consistently predicted incident MCI across the two races. Future work should expand upon these results through replication in other diverse samples, inclusion of informant report data, and investigation of differential change in SCC over time and in relation to clinical conversion.