Older Latino Adults Research Articles

Heterogeneity in cognitive profiles of monolingual and bilingual Hispanic/Latino older adults in HABS-HD.

The present study characterized heterogeneity in the cognitive profiles of monolingual and bilingual Latino older adults enrolled in the HABS-HD. A total of 859 cognitively unimpaired older adults completed neuropsychological testing. Raw scores for cognitive tests were converted to z-scores adjusted for age, education, sex, and language of testing. A latent profile analysis (LPA) was conducted for monolingual and bilingual speaker groups. A series of 2-5 class solutions were examined, and the optimal model was selected based on fit indices, posterior probabilities, proportion of sample sizes, and pattern of scores. Identified classes were compared on sociodemographic, psychosocial, and health characteristics. For the monolingual group (n = 365), a 3-class solution was optimal; this consisted of a Low Average Memory group with low average verbal memory performances on the SEVLT Total Learning and Delayed Recall trials, as well as an Average Cognition group and a High Average Cognition group. For the bilingual group (n = 494), a 3-class solution was observed to be optimal; this consisted of a Low Average Memory group, with low average verbal memory performances on the learning and delayed recall trials of Logical Memory; a Low Average Executive group, where performance on Trails A and B and Digit Substitution were the lowest; and a High Average Cognition group, where performance was generally in the high average range across most cognitive measures. Cognitive class solutions differed across monolingual and bilingual groups and illustrate the need to better understand cognitive variability in linguistically diverse samples of Latino older adults.

Specific cultural traits of the precarity of older Latinos living alone with cognitive impairment in the San Francisco Bay Area

Objectives Latinos are about twice as likely to develop cognitive impairment. Culturally, filial support and familismo are expected within Latino families. Yet approximately twenty percent of Latinos live alone in the United States. The purpose of this study is to explore the concerns and priorities of older Latinos living alone with cognitive impairment, using a precarity framework. Method We conducted 22 in-home interviews with older Latinos living alone with cognitive impairment, and we supplemented the interviews with interviews with members of the older adults’ social circle and providers. Themes influencing the precarity of Latino older adults living alone were organized through the major areas of the precarity lens; 1) Limited awareness of cognitive impairment; 2) Self-management of cognitive impairment; and 3) Lacking tailored services for cognitive impairment. Results Latino culture permeated and intersected across the lived experiences of participants living alone with cognitive impairment. Precarity was prevalent in all participants’ lives and was exacerbated by familismo combined with cognitive impairment. Conclusion Findings showed precarity in the experiences the participants shared. Participant narratives reveal how the Latino culture intersects with the experience of precarity while living alone with cognitive impairment, especially in reference to the role that family plays through the expectation of familismo. However, given the difficult demands of employment and raising their own families, familismo can become more like a goal than a practice. Further research is needed to better understand how to bridge the gap between the needs of these older Latino adults living alone with cognitive impairment, their families, and formal services.

A - 73 The Effects of Socioeconomic Status, Depression, and Chronic Stress on Cognitive Outcomes of Latino Older Adults Enrolled in HABS-HD

Abstract Objective Although research has established that lower socioeconomic status (SES) is linked to worse cognitive functioning in Latino older adults, the precise mechanisms underlying this association remain unclear. SES has been linked to the manifestation and severity of depression and anxiety, and evidence suggests that Latinos may be more susceptible to the negative effects of these psychological factors in late life. Therefore, the present study examined the mediating role of psychological symptomatology in the relationship between SES and cognition. Method 736 Latino older adults (mean age = 62.67) enrolled in HABS-HD were included. Mediation analysis tested the direct and indirect effects of SES (annual household income) and psychological symptomatology (depression, chronic stress) on memory and executive functioning composite scores. Results The direct effect of SES on memory was fully mediated by depression (β = 0.02, CI [0.01, 0.04]), and depression partially mediated the relationship between SES and executive functioning (β = 0.02, CI [0.01, 0.04]). There were no significant indirect effects of chronic stress on SES and memory (β = −0.0003, CI [−0.003, 0.002]) or executive functioning composite scores (β = 0.0004, CI [−0.002, 0.003]). However, after controlling for chronic stress, SES had a direct effect on executive functioning (β = 0.12, CI [0.03, 0.12], p = 0.001), but not memory (β = 0.03, CI [−0.03, 0.07], p = 0.48). Conclusions The effect of SES on cognition is mediated by depressive symptomatology but not chronic stress. Results suggest that culturally tailored treatment of depression may be an immediate intervention against long-standing resource inequalities.

Identifying Preferences and Barriers to Psychiatric Video-Telemedicine Use Among Older Latino Adults With Limited English Proficiency During the COVID-19 Pandemic

IntroductionThis study explored reasons for the nonuse of video-telemedicine among Latino patients with limited English proficiency (LEP) in a geriatric psychiatry clinic during the COVID-19 pandemic (January to December 2021). MethodsForty-two older Latino patients with LEP who exclusively used audio-telemedicine completed a 33-item survey regarding their reasons for not using video-telemedicine and possible explanatory factors. ResultsThe majority of patients had access to technology and technology assistance from friends and family. Thirty-three patients (79%) reported a lack of technical skills as the main reason for not using video-telemedicine; nine patients (21%) cited other main reasons, including privacy or confidentiality concerns. Patients lacking technical skills were 4.6 times more likely to report no comfort using English compared to patients who cited other reasons. ConclusionA lack of digital literacy and no comfort with English were related factors impacting video-telemedicine use among older Latino patients with LEP during the COVID-19 pandemic.

Experiences managing behavioral symptoms among Latino caregivers of Latino older adults with dementia and memory problems: a qualitative study

BackgroundLatinos are more likely than non-Latino Whites to develop dementia and be prescribed antipsychotics for dementia-related behavioral symptoms. Antipsychotics have significant risks yet are often overprescribed. Our understanding of how Latino caregivers of Latino older adults living with dementia perceive and address behavioral issues is limited, impeding our ability to address the root causes of antipsychotic overprescribing.MethodsWe interviewed Latino older adults’ caregivers and community-based organization workers serving older adults with cognitive impairment (key informants), focusing on the management of behavioral symptoms and experiences with health services.ResultsWe interviewed 8 caregivers and 2 key informants. Caregivers were the spouses, children, or grandchildren of the older adult living with cognitive impairment; their ages ranged from 30 to 95. We identified three categories of how caregivers learned about, managed, and coped with behavioral symptoms: caregivers often faced shortcomings with dementia care in the medical system, receiving limited guidance and support; caregivers found community organizations and senior day centers to be lifelines, as they received relevant, timely advice and support, caregivers often devised their own creative strategies to manage behavioral symptoms.ConclusionIn-depth interviews suggest that the healthcare system is failing to provide support for behavioral symptoms from dementia; caregivers of Latino older adults rely on community organizations instead.

Preventing Cognitive Decline in Older Latino Adults With HIV Through a Culturally Tailored Health Promotion Intervention: Protocol for a Single-Arm Pilot Trial.

Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100% of the targeted sample (N=30), with 20% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80% (n=38) or more of sessions attended by participants. Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709. DERR1-10.2196/55507.

The Need for Culturally Tailored CKD Education in Older Latino Patients and Their Families

Older Latino adults (65+) comprise the fastest growing minoritized group among the older population in the US and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared to non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision-making and have been shown to improve decisional quality and goal-concordant care among older patients with CKD. In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.

"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services.

Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

Enhancing End-of-Life Care Knowledge Among Older Spanish-Speaking Adults: Results From a Pilot Educational Intervention on Advance Care Planning and Care Options.

Disparities in advance care planning (ACP) among older Latinos necessitate targeted interventions to enhance engagement and knowledge in end-of-life care. This study aimed to evaluate the effectiveness of a resource-efficient, culturally tailored educational intervention in improving ACP readiness and knowledge among older Latino adults in the community. A quasi-experimental pretest-posttest design was used to assess the impact of the intervention. The study involved community-dwelling older Latinos (aged 61-94) in the U.S. attending community wellness centers. Measures included participants' knowledge of ACP, care options, familiarity with hospice and palliative care, and attitudes toward hospice, assessed using pre- and post-intervention surveys. Statistically significant improvements were observed in ACP knowledge, understanding of care options, and attitudes towards hospice and palliative care post-intervention. Demographic factors influenced knowledge scores, with no significant gender differences in the intervention's efficacy. The educational intervention effectively enhanced end-of-life care planning readiness and knowledge among older Latinos. The study highlights the potential for sustainable, accessible, and culturally sensitive educational strategies to reduce disparities in ACP knowledge and possibly engagement.

Diminished returns of educational attainment on life satisfaction among Black and Latino older adults transitioning into retirement

BackgroundThis paper investigates the intricate relationship between race/ethnicity, educational attainment, and life satisfaction among middle-aged and older adults in the United States. Guided by the theory of Minorities' Diminished Returns (MDRs), positing that returns on educational attainment are attenuated for minoritized populations, this study aims to explore racial/ethnic disparities in the impact of educational attainment on the life satisfaction of middle-aged and older adults. MethodsThis was a secondary analysis of existing data. Utilizing data from the Health and Retirement Study (HRS), we employed a longitudinal design with a nationally representative sample of middle-aged and older adults in the United States. Key variables of interest included educational attainment, race/ethnicity, and average life satisfaction from wave 9–15 (20–30 years later). Statistical analysis included regression models to assess the associations between educational attainment and life satisfaction overall and by race and ethnicity. ResultsOverall, 5274 participants entered our analysis and were followed for up to 30 years. Our initial findings revealed a positive association between educational attainment and life satisfaction. Subsequently, we identified significant interactions between race/ethnicity and educational attainment, indicating notable racial and ethnic differences in the impact of educational attainment on life satisfaction. The effects of baseline on future educational attainment and life satisfaction were weaker for Black and Latino than non-Latino White counterparts. ConclusionsIn accordance with the Minorities' Diminished Returns theory, Black and Latino middle-aged and older adults experience a less pronounced positive impact of educational attainment on life satisfaction compared to their Non-Latino and White counterparts. There are non-additive complex interplay between educational attainment and race and ethnicity on subjective well-being of middle-aged and older adults. The identified disparities in the returns of educational attainment underscore the critical need to recognize and address structural barriers that contribute to the diminished returns of educational attainment for Black and Latino populations.

Identifying Factors That Influence Physical Activity and Healthy Aging Among Older Latino Adults.

For older Latinos, some benefits of leisure-time physical activity (LTPA) include enhanced cognitive functioning, decreased loneliness, and reduced premature mortality. Despite LTPA benefits, adults ≥50 years are one of the most inactive age groups in the United States. This qualitative study aimed to add to the limited evidence of LTPA in older Latino adults by exploring the barriers and facilitators for fitness class uptake and park use. Guided by a Social-Ecological Model of Health and Social Determinants of Health theoretical and a phenomenological research design, qualitative research data were collected via 27 personal interviews with Latino adults using a semistructured interview guide. Participants were recruited using purposive sampling strategies in collaboration with community partners. Bicultural data collectors conducted the semistructured interviews over Zoom. Thematic analysis was performed using Dedoose, following an inductive and deductive approach. The main barriers to fitness class attendance and park use were family and/or work commitments, perceived safety, and perceived discrimination. Conversely, the critical facilitators for participation were socialization into a group, social connectedness with group members, fitness instructor characteristics, and exercise history. Findings from this study hold important implications for the design of fitness programming and park-based recreation, including the need to increase the cultural diversity of recreation staff and culturally relevant programming. Future research is needed on time poverty related to family/work commitments and whether discriminatory practices at fitness centers, like ageism and race/ethnicity, influence physical activity behavior.

PHYSICAL AND MENTAL HEALTH INFORMATION-SEEKING BEHAVIORS AMONG US-BASED LATINO ADULTS AGES 50–86

Abstract Introduction As U.S.-based Latino populations disproportionately experience chronic disease and age earlier than their non-Latino white counterparts, attentiveness to knowledge gaps in health communication is critical to address health disparities among Latino older adults. Methods We conducted a cross-sectional survey among U.S.-based Latinos ages 50-86 (N=274; 2021) that measured physical and mental health information seeking across four sources—TV/radio/print-media, Internet/social-media, family/friends, and healthcare providers. Linear regression models examined patterns of personal, family, and mental health factors on each information seeking outcome. Results Foreign-born Latinos had lower odds of mental health info-seeking on Internet/social media (p< 0.05) than U.S.-born Latinos. Compared to higher educational attainment, low education reduced odds of physical/mental health info-seeking in all media sources (p< 0.05). Family mental health history vs none saw 3-5 times the odds of physical/mental health info-seeking to all sources (p< 0.01). Additionally, moderate/severe mental health vs mild/none was associated with 2-3 times the odds of physical/mental health info-seeking among family/friends and healthcare providers (p< 0.01). English media use increased odds of physical health info-seeking in TV/radio/print-media and family/friends (p< 0.05), while Spanish/English media use increased odds of mental health info-seeking to healthcare providers (p< 0.05). Conclusions Latino older adults report diverse yet unique patterns in health information acquisition. Those with self/familial mental illness especially seek health information more often than Latinos without a lived experience. Findings demonstrate the need to apply culturally appropriate health communication strategies to address the needs of older Latino adults, with special focus on families coping with mental illnesses.

VOICES OF LOW-INCOME LATINO OLDER ADULTS: WHAT ARE THEIR PERCEIVED LEARNING IMPEDIMENTS?

Abstract Cognitive and functional health disparities between Latino and White older adults show that Latinos have a higher risk for developing Alzheimer’s and related dementias (ADRD) in the United States. Such risk compromises Latino’s likelihood of becoming healthy agers, which is of high concern as they are one of the largest and fastest-growing minoritized groups in the United States. Nonetheless, there is a lack of research aiming to understand how to increase their cognitive and functional abilities. One way of stimulating cognitive and functional growth is through learning of new skills. However, learning is a privilege, and this population may face unique barriers to learning that other racial/ethnic groups may not, especially if they have a low income. This qualitative study focused on identifying the barriers to novel skill learning engagement of low-income Latino older adults. A total of 20 low-income, Latino older adults were interviewed in Spanish over the phone utilizing a semi-structured interview protocol. Themes were derived from the data using a thematic analysis approach. Our results showed that the following barriers were most common among our participants: health problems (80%), lack of money (75%), lack of awareness/knowledge of learning opportunities (75%), lack of technology access/literacy (75%), lack of proficiency in the English language (65%), lack of reliable transportation (55%), and lack of motivation due to being “old” (50%). These findings help inform learning program leaders, policymakers, and future learning interventions on the barriers that should be addressed for minoritized populations.

SHAPING COVID-19 INTERVENTIONS THAT ADDRESS SOCIAL BARRIERS AMONG OLDER LATINOS IN ASSISTED LIVING FACILITIES

Abstract COVID-19 has exposed severe gaps in our understanding of preventing infectious diseases, particularly in congregate living facilities. While the medical and public health communities developed clear insights into preventing or limiting the spread of infection, our understanding of barriers to adopting these measures has lagged, particularly in minority communities. The COVID-19 pandemic has disproportionately affected older Latino adults, particularly those living in assisted living facilities. Among this vulnerable population, older Latinos face unique social barriers such as language and communication difficulties, lack of culturally competent care, and socioeconomic disadvantages that contribute to their increased susceptibility to COVID-19 transmission and which can lead to more severe outcomes. While initial intervention strategies focused on medical interventions to mitigate the virus’s effects, there has been a gradual recognition that barriers to prevention have increasingly shifted from medical to social domains. This paper aims to document the existing knowledge and identify knowledge gaps concerning effectively managing these social barriers. Culturally sensitive approaches must consider salient features of Latino family dynamics such as allocentrism, familismo, respeto, and expected gender roles. In addition, there are often barriers related to external factors, such as a lack of Spanish language resources, community engagement, stereotypes, and racism. Prevention approaches need to identify and address these barriers to safeguard the well-being of older Latinos in assisted living facilities during the COVID-19 pandemic. This review will explore our current understanding of these social barriers, provide insights into potential strategies to mitigate their impact and identify continuing gaps in our knowledge.

MULTILEVEL LIFESTYLE INTERVENTIONS ARE NEEDED TO IMPROVE DIABETES SELF-MANAGEMENT IN OLDER ADULTS

Abstract Type 2 diabetes (T2D) is a major public health concern in older adults. Physical activity (PA) and healthy eating (HE) are two major lifestyle intervention strategies in diabetes self-management for controlling glucose levels, preventing complications, and improving functionality and quality of life. This qualitative study aimed to explore perceived factors influencing PA and HE among predominately Latino older adults with T2D ((age=70.5±4.8; Latinos=73.3%). We conducted semi-structured interviews with 15 community dwelling older adults with T2D at the end of a 12-week pre- and post- study assessing self-monitoring on lifestyles and health outcomes. All interviews were recorded and transcribed. Two researchers analyzed the data independently using a combination of deductive and inductive thematical analysis. Codes were categorized into five themes based on the socio-ecological framework, and sub-themes were identified. The themes included five levels of factors: 1) individual (e.g., knowledge, self-efficacy, self-monitoring, perceived benefits and threats, health status,); 2) interpersonal (e.g., family, friend, health provider); 3) organizational (e.g., availability of physical activity equipment in senior apartments); 4) environment (e.g., culture norms); and 5) policy factors (e.g., health provider, retirement). The factors in one level could influence the factors in another level. Most current lifestyle interventions focus on individual level, and multilevel lifestyle interventions to promote healthy lifestyles, and improve health, independence, and quality of life in older adults with T2D are warranted. The input of additional stakeholders such as family members and community staff need to be accounted when designing multilevel intervention in older adults with T2D.

Bilingual neurocognitive resiliency, vulnerability, and Alzheimer’s disease biomarkers in Latino older adults enrolled in the Health and Aging Brain Study‐Health Disparities (HABS‐HD)

AbstractBackgroundAlthough bilingualism has been associated with cognitive reserve and a later age of dementia onset (e.g., Alladi et al., 2013, 2017; Bialystok et al., 2007, 2010; de Leon et al., 2020), the effects of bilingualism on neuropsychological test performance in bilinguals with and without cognitive impairment have not yet been thoroughly investigated (e.g., Briceño et al., 2021; Cherner et al., 2021; Padilla et al., 2016).MethodThe present study explored patterns of cognitive performance and impairment across a large sample of bilingual and monolingual Latino older adults from the Health and Aging Brain: Health Disparities cohort (O’Bryant et al., 2021). In addition to examining differences between bilinguals and monolinguals, the associations between specific bilingual factors (i.e., dominance and age of acquisition) and cognitive performance were examined in order to elucidate which components of the bilingual experience explain such associations.ResultBilingual speakers demonstrated a pattern of cognitive resiliency in the form of better performance on attention/processing speed that can be observed across the cognitively unimpaired (Trails A, p = .001; Trails B, p = .02; Digit Substitution p = .004, and Logical Memory I p = .04) and mild cognitive impairment (Trails A, p < .001 and Digit Substitution, p < .02) diagnostic spectrum. In contrast, bilingual speakers demonstrated a pattern of cognitive vulnerability in the form of poorer performance and higher rates of impairment on a language measure that is only evident in the MCI phase (letter fluency, p = .001). Follow‐up analyses revealed bilinguals that 1) had a later age of language acquisition or 2) unbalanced language dominance performed more poorly on cognitive testing (Table 1) and had higher rates of impairment (Table 2). Exploratory analyses revealed that bilinguals with impaired language scores demonstrated lower levels of plasma Ab 42/40 relative (indicative of greater AD pathology) to unimpaired bilinguals (p = .02; Figure 1).ConclusionResults suggest that patterns of cognitive performance and impairment differ as a function of bilingualism. Bilingual factors must be considered in clinical and research investigations centered on evaluating cognitive outcomes of Latino older adults.

Associations among depressive symptoms, hippocampal volume and cognition in community‐dwelling older Latinos

AbstractBackgroundLatinos are the fastest growing subpopulation of older adults in the U.S. and have a higher risk for dementia than non‐Latino Whites. Depressive symptoms are prevalent among US Latinos. However, these symptoms often go undiagnosed and are undertreated. Depressive symptoms may be early manifestations of Alzheimer’s Disease (AD) before the onset of mild cognitive impairment and dementia. It’s unclear whether depressive symptoms in the presence of incipient neurodegeneration are associated with cognitive function in older Latino adults. Here, we examined the associations among depressive symptoms, cognition and hippocampal volume in older Latinos.MethodA total of 65 Spanish‐speaking Latinos enrolled in the Boston Latino Aging Study (BLAST) and the Harvard Aging Brain Study (HABS) were included. Depressive symptoms were assessed with the 30‐item‐Geriatric Depression Scale (GDS) and cognition with the Preclinical Alzheimer’s Cognitive Composite (PACC5), which includes the Mini‐Mental State Examination (MMSE), Digit Symbol Coding, Free and Cued Selective Reminding Test, Category Fluency (animals) and Logical Memory Delayed Recall (NEUROPSI Stories for BLAST participants). A subset of 34 participants also underwent a structural brain MRI on a 3T scanner. Spearman correlations were used to determine cross‐sectional associations among depressive symptoms, hippocampal volume, and cognition. Models were adjusted for age and education.ResultsParticipants had a mean age of 66 +/‐ 7.2 years, a mean education of 12.9 +/‐ 5.1 years, and 74% were female. They had a mean MMSE score of 26.7 +/‐ 2.8, a mean GDS score of 6.1 +/‐ 5.5 and a mean adjusted hippocampal volume of 7836.5 +/ = 630.9 mm3. Correlation analyses revealed that higher depressive symptoms were associated with lower years of education (r = ‐0.39, p<0.001), worse performance on cognitive measures (r = ‐0.33, p = 0.009) and smaller hippocampal volume (r = ‐0.61, p = <0.001).ConclusionsPreliminary results of this ongoing biomarker study suggest that depressive symptoms in older Latinos are associated with markers of neurodegeneration (i.e., hippocampal volume) and worse cognition. Future work will focus on investigating predictors of long‐term emotional and cognitive functioning in Spanish‐speaking, older Latino populations.

The relationship between Structural, PET, and Plasma Alzheimer’s Disease Biomarkers and neuropsychological composites among Latino bilinguals and monolinguals

AbstractBackgroundEstimates from the Alzheimer’s Association indicate that approximately one in ten older adults in the US have Alzheimer’s disease (AD) dementia while 15 to 20% have mild cognitive impairment (MCI), projecting that about a third of those will develop dementia within five years. The Cognitive Reserve/ Resilience (CR/R) theory postulates that complex mental activity throughout the lifetime builds resilience to cognitive decline despite the biological risk (a neurodegenerative disease). Emerging evidence shows that bilingualism may be one of these neuroprotective factors in the aging brain, but results in bilingualism and CR/R remain inconsistent.MethodsWe studied 238 Latino older adults (age 71.8 ± 8.0 years old, 65% female) from the 1Florida Alzheimer’s Disease Research Center who were diagnosed as clinically normal, MCI, or dementia. Of these, 158 were Spanish‐English bilinguals and 80 were Spanish monolinguals. Bilingualism was assessed by a proficiency questionnaire. Six cognitive composites were developed (Figure 1). We investigated cognitive test correlates of plasma P‐tau181 (Quanterix simoa), hippocampal volume, and amyloid PET (Centiloid) biomarkers in both language groups, using 2×3 ANCOVAs (controlling for age and level of education). We analyzed correlations between biomarkers and cognition and performed multiple regression analyses within each language group.ResultsThe main effect of the diagnostic group was significant for all biomarkers (ps < .001). There was no main effect of the language group and no significant interactions. The correlations between biomarkers were equally significant for both language groups but differences in the association of biomarkers with cognitive tests emerged between language groups. Bilinguals showed a stronger negative association between hippocampal volume and cognitive test scores than monolinguals. In bilinguals, higher PTau181 was associated with lower visuomotor composite scores, while amyloid PET positivity and lower hippocampal volume were associated with cognitive stress and working memory. In monolinguals, higher PTau181 was associated with worse inhibitory control, and amyloid PET positivity and lower hippocampal volume were associated with worse memory.ConclusionResults demonstrated discrepancies between bilingual and monolingual Latinos in the associations between cognitive composites and AD biomarkers. Further exploring the relationship between bilingualism, cognitive test scores, and biomarker patterns is warranted, especially longitudinally.

Bilingualism in the Clinical Diagnosis of Mild Cognitive Impairment and Dementia

AbstractBackgroundNeuropsychological assessments determine the presence of cognitive impairment in Alzheimer’s Disease and Related Dementias (ADRD). These tests are susceptible to the influence of cultural and linguistic variables. Bilingualism is a potential contributor to cognitive reserve in elderly individuals. Positive effects of bilingualism have been observed in executive function tasks, while negative effects have been reported on verbal fluency tests. Maintaining two active languages may modify cognitive and brain reserve among bilinguals, but evidence is inconsistent and contradictory. We investigated the relationship between bilingualism and neuropsychological test performance in aging participants from the 1Florida ADRC using a longitudinal design.MethodsWe studied 238 Latino older adults (age 71.79 ± 8.01 years old, 65% female). 158 Latino participants were Spanish‐English bilinguals; 80 were Spanish monolinguals. Bilingualism was assessed by a proficiency questionnaire. Six cognitive composites were developed (Figure 1). We investigated cognitive test change scores between language group, visit (2 visits: M = 14.61 months; SD = 3.52), and diagnosis (normal, MCI, dementia) using 2×2×3 repeated measures ANCOVAs (age and level of education). Cognitive scores were correlated with frontal and temporal brain volumes in bilinguals and monolinguals separately.ResultsMain effects of the diagnostic group and visit were significant for all composites (ps < .001), with the dementia group showing the lowest scores. No significant main effect of Bilingualism was observed for any of the composites. An interaction between visit and bilingualism was seen for the Trail Making Test B‐ A. Three‐way interactions were found between diagnostic groups, visit, and bilingualism for the Verbal composite and the Logical Memory delay subtest (part of the Memory composite). A more significant decline in the monolingual groups was observed, more so in the dementia group. Significant correlations were found between most composites in both language groups, being more related to the temporal than frontal lobe areas, using MRI volumetric measures.ConclusionBilingualism seems to interact with cognitive decline in aging. It is essential to consider the individual’s level of bilingualism to obtain an accurate assessment of cognitive impairment. The interaction of bilingualism with other sociodemographic and cognitive variables will be discussed.

5 Poorer Memory Outcomes are Observed in Underinsured Latino Older Adults with Metabolic Syndrome

Objective:Metabolic Syndrome (MetS) is a constellation of deleterious cardiometabolic health conditions (e.g., diabetes, hypertension) that have been linked to cognitive impairment and accelerated cognitive decline in older adults. Research has shown that Latinos are at increased risk for developing MetS relative to non-Latino Whites and the prevention, maintenance, and treatment of cardiometabolic risk factors are largely contingent upon health insurance status. Within the United States there are considerable state-based differences in eligibility and access to health insurance coverage. Although Texas has the second largest population of Latinos, they are one of the most underinsured groups within the state. There is some evidence to suggest that inconsistent healthcare is associated with cognitive impairment among underserved/underprivileged groups. The current study sought to examine whether insurance status moderates the association between MetS and cognitive functioning in an effort to inform public health policy initiatives vital to reducing age-related health disparities amongst Latino older adults residing in Texas.Participants and Methods:The study sample included 850 primarily Spanish-speaking (67.6%) Latino older adults (mean age = 63.1±7.81) largely of Mexican origin/descent (95%) enrolled in the Health and Aging Brain Study-Health Disparities. All participants completed neuropsychological testing, a health exam, and questions about health insurance coverage. MetS status (MetS+ vs. MetS-) was determined by abnormal clinical abdominal obesity, triglycerides, high-density lipoprotein, blood pressure, and fasting glucose values. Health insurance status was determined by current enrollment in any private or public insurance plan. Cognition was assessed with Digit Span, Logical Memory I and II, Trail Making Test (A and B), Spanish-English Verbal Learning Test, and Letter Fluency (FAS). Raw scores were converted to z-scores which were subsequently averaged into two distinct memory and executive functioning composite scores. ANCOVAs controlling for age, sex, education, APOE e4 positivity, annual income, and primary language status were used examine health insurance status x MetS interactions on cognitive composites.Results:Approximately 54.6% of the sample met clinical criteria for MetS+ and 23.6% endorsed having no health insurance. There were no significant group differences in the proportion of MetS+ and MetS- individuals with and without health insurance (X 2 = .002, p =.96). Results revealed there was a significant MetS x health insurance status interaction on the memory composite (F = 5.39, p = .02). Post-hoc comparisons revealed that Latino older adults without health insurance demonstrated poorer memory performance relative to those with health insurance in the MetS+ group (p=.02). In contrast, there were no significant differences in memory performance across insurance status in the MetS- group (p=.35). Finally, there was no significant MetS x health insurance interaction on executive functioning (p=.60).Conclusions:Findings revealed that health insurance coverage differentially impacts memory, but not executive functioning, amongst Latinos with MetS+. Underinsured Latinos with chronic cardiometabolic health conditions may be at risk for poor memory outcomes and increasing access to affordable healthcare could help mitigate the adverse effects of MetS+ on memory. Future studies examining the relationship between health insurance, MetS status, and neuroimaging markers may yield additional insight into mechanisms underlying age-related dementia disparities.