Racial/Ethnic Differences in Correspondence Between Subjective Cognitive Ratings and Cognitive Impairment

Abstract

Responding to racial/ethnic disparities in dementia diagnosis and care, we examined the role of race/ethnicity in the correspondence between subjective and objective ratings of cognitive impairment. Our examination focused on the two types of discordance: (1) positive ratings in the presence of cognitive impairment and (2) negative ratings in the absence of cognitive impairment. A cross-sectional assessment was conducted using the data from the Harmonized Cognitive Assessment Protocol project, a sub-study of the Health and Retirement Study. Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics. Discordant groups were identified based on self-ratings of cognition (positive versus negative) and the Langa-Weir classification of cognitive impairment (normal versus impaired). Blacks and Hispanics were more prone to falsely positive perceptions of their cognitive function in the presence of cognitive impairment than non-Hispanic Whites. On the other hand, non-Hispanic Whites were more likely to manifest negative ratings even in the absence of cognitive impairment. Our findings demonstrate the critical role of race/ethnicity in determining discordance between subjective and objective measures of cognition and highlight the importance of a tailored effort to promote dementia diagnosis and care.