Cognitive and Socio‐Demographic Factors Related to Subjective Cognitive Decline in Native Americans

Abstract

AbstractBackgroundSubjective cognitive decline (SCD) is commonly reported in neuropsychological evaluation, but self‐reported SCD can be influenced by anosognosia and depressed mood. Cognitive decline reported by a close informant, such as a spouse, may be more predictive of objective cognitive decline than a patient’s self‐report (Bellaali et al., 2021). Recent research comparing how racial and ethnic groups report SCD found strong evidence that Native Americans and their close informants reported SCD more frequently than White and Black Americans (Dixon & Woodard, N.D.). This study investigates whether unique socio‐demographic or cognitive variables could account for this phenomenon.MethodParticipants were selected from the National Alzheimer’s Coordinating Center (NACC) database. Participants were cognitively healthy at baseline, at least 65 years of age, and had an informant who lived with or visited the participant weekly (N = 9355). Participant racial groups included White Americans (n = 7770), Black Americans (n = 1517), and Native Americans/Alaskans (n = 68). Pairwise comparisons compared objective cognitive performance on the Mini‐Mental State Examination (MMSE), clinician‐determined functional decline, level of independence, educational attainment, self‐reported anxiety, Geriatric Depression Scale (GDS), and history of tobacco and substance abuse between each racial group using Bayesian contingency tables and t‐tests to find reliable evidence supporting the null or alternative hypothesis.ResultGroup comparisons indicated no reliable differences between Native Americans and the other racial groups on clinician‐determined functional decline, level of independence, self‐reported anxiety, tobacco use, and substance abuse (BF10 < 3). White Americans had significantly higher educational attainment and performed better on the MMSE (BF10 > 100) than Black and Native Americans. Native Americans exhibited reliably higher GDS scores than White (BF10 = 5.5) and Black (BF10 = 10.4) Americans.ConclusionThe greater rate of SCD reported by Native Americans and their close informants compared with White and Black Americans may be related to significantly higher rates of depressive symptoms reported by Native Americans/Alaskans. Careful evaluation of mood symptoms may be particularly important for clinicians working with Native American/Alaskan patients to differentiate between SCD and objective cognitive impairment.