Subjective cognitive concerns differ by race/ethnicity among einstein aging study (EAS) participants: Implications for assessment and interpretation of self‐perceived cognitive functioning

Abstract

AbstractBackgroundSubjective cognitive concerns (SCC) play an important role in the identification of preclinical dementia, especially among individuals who have experienced health disparities. It is critical to discern differential patterns of SCC endorsement among racially/ethnically diverse groups to enhance the ability to accurately capture current and future cognitive status. Moreover, it is important to determine whether the association of SCCs and objective neuropsychological test scores vary by racial/ethnic background.MethodUsing data from the EAS, a longitudinal community residing cohort aged 70+, SCCs were captured using an expanded version of the Cognitive Change Index (CCI‐40), which taps multiple cognitive domains. Objective cognition was measured using the FCSRT and tests from the Uniform Data Set, Neuropsychological Battery (UDSNB3.0). Linear regression models evaluated racial/ethnic differences in SCC at baseline. Additional models for objective cognition examined its association with SCC adjusting for racial/ethnic groups, and furthermore the interaction effects between race/ethnicity and SCC. Covariates included demographics, depressive symptoms, income, and co‐morbidities.ResultWe included 313 participants of non‐Hispanic (NH) White (47%), NH Black (40%) and Hispanic/Latino (13%) racial/ethnic groups who were not demented at baseline. NH Blacks and Hispanic/Latino participants reported significantly more SCC than NH Whites after adjusting for covariates. Higher CCI‐40 scores were associated with worse FCSRT free recall and Trail Making Test Part B performing, adjusting for race and other covariates. When interactions between race/ethnicity and CCI‐40 were included, higher levels of SCC were associated with lower MoCA and FCSRT free recall scores for NH Whites but not for NH Blacks.ConclusionStronger perceptions of self‐reported cognitive decline do not necessarily correspond to worse performance on memory and global cognitive tasks for all racial groups. Although racial/ethnic differences were found in levels of SCC, it is important to investigate factors that may influence self‐perceived cognitive functioning for specific groups (e.g., health status, social support), and the consequential impact on access to healthcare settings (where assessment and diagnosis typically occur). In addition, researchers should consider diversity variables when setting cut points on self‐report questionnaires to enhance diagnostic sensitivity and inform optimal assessment and monitoring needs.