Racial differences in neurocognitive outcomes post-stroke: The impact of healthcare variables

AbstractObjectives:The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.Methods:One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age:M=56.4;SD=12.6; education:M=13.7;SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.Results:An independent samplesttest indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score:M=37.63;SD=11.67) than Whites (Fluid T-score:M=42.59,SD=11.54;p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p&lt;.001 andp=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.Conclusions:We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017,23, 640–652)</jats:p

Physical exercise is associated with less neurocognitive impairment among HIV-infected adults

Abstract Neurocognitive impairment (NCI) remains prevalent in HIV infection. Randomized trials have shown that physical exercise improves NCI in non-HIV-infected adults, but data on HIV-infected populations are limited. Communitydwelling HIV-infected participants (n=335) completed a comprehensive neurocognitive battery that was utilized to define both global and domain-specific NCI. Participants were divided into &quot;exercise&quot; (n=83) and &quot;no exercise&quot; (n=252) groups based on whether they self-reported engaging in any activity that increased heart rate in the last 72 h or not. We also measured and evaluated a series of potential confounding factors, including demographics, HIV disease characteristics, substance use and psychiatric comorbidities, and physical functioning. Lower rates of global NCI were observed among the exercise group (15.7 %) as compared to those in the no exercise group (31.0 %; p&lt;0.01). A multivariable logistic regression controlling for potential confounds (i.e., education, AIDS status, current CD4+ lymphocyte count, self-reported physical function, current depression) showed that being in the exercise group remained significantly associated with lower global NCI (odds ratio=2.63, p&lt;0.05). Similar models of domain-specific NCI showed that exercise was associated with reduced impairment in working memory (p&lt;0.05) and speed of information processing (p&lt;0.05). The present findings suggest that HIVinfected adults who exercise are approximately half as likely to show NCI as compared to those who do not. Future longitudinal studies might be best suited to address causality, and intervention trials in HIV-infected individuals will determine whether exercise can prevent or ameliorate NCI in this population

Successful Aging Among Older Hispanics

Abstract Successful Aging has been defined as the absence of objective physical, cognitive, and social difficulties. More recently, self-rated successful aging (SRSA) has been recognized as an important outcome in its own right. The purpose of this study was to assess SRSA and its correlates among older Hispanics/Latinos. Seventy-four Hispanic/Latino adults age 50+ (31.9% primarily Spanish-speaking; 62.5% women, mean age=69.6±12.2, mean years of education=14.3±3.3) completed a measure of SRSA (scaled from 1 [lowest] to 10 [highest]), and self-report measures of hypothesized correlates, including culturally-relevant factors (language use, acculturation, fatalism, familism, perceived discrimination and frame of reference), as well as physical (perception of physical health and physical performance), cognitive (perception of cognitive problems), and psychosocial correlates (social functioning and resilience). Fifty-five percent of the participants reported SRSA of 8 or above (mean=7.99±, range: 3-10). Factors that were significantly associated with SRSA in univariable models, were entered into a multiple linear regression on SRSA. The final multivariable model explained 58.5% of the variance on SRSA (F(3,54)=27.8, p&lt;.001) and showed that social functioning (B=.21; p=.031), resilience (B=.34; p=.002), and perception of physical health (scaled from 1 [highest] to 5 [lowest]), (B=-.43; p&lt;.001) were independent predictors of SRSA. Culturally-relevant factors were not independently associated with SRSA in the multivariable model. While future longitudinal studies would be better suited to address causality, the present cross-sectional findings indicate psychosocial correlates of SRSA are as important as physical correlates among older Latinos. Future studies might examine whether culturally relevant factors modify these associations

Successful Aging Among Older Hispanics

Abstract Successful Aging has been defined as the absence of objective physical, cognitive, and social difficulties. More recently, self-rated successful aging (SRSA) has been recognized as an important outcome in its own right. The purpose of this study was to assess SRSA and its correlates among older Hispanics/Latinos. Seventy-four Hispanic/Latino adults age 50+ (31.9% primarily Spanish-speaking; 62.5% women, mean age=69.6±12.2, mean years of education=14.3±3.3) completed a measure of SRSA (scaled from 1 [lowest] to 10 [highest]), and self-report measures of hypothesized correlates, including culturally-relevant factors (language use, acculturation, fatalism, familism, perceived discrimination and frame of reference), as well as physical (perception of physical health and physical performance), cognitive (perception of cognitive problems), and psychosocial correlates (social functioning and resilience). Fifty-five percent of the participants reported SRSA of 8 or above (mean=7.99±, range: 3-10). Factors that were significantly associated with SRSA in univariable models, were entered into a multiple linear regression on SRSA. The final multivariable model explained 58.5% of the variance on SRSA (F(3,54)=27.8, p&lt;.001) and showed that social functioning (B=.21; p=.031), resilience (B=.34; p=.002), and perception of physical health (scaled from 1 [highest] to 5 [lowest]), (B=-.43; p&lt;.001) were independent predictors of SRSA. Culturally-relevant factors were not independently associated with SRSA in the multivariable model. While future longitudinal studies would be better suited to address causality, the present cross-sectional findings indicate psychosocial correlates of SRSA are as important as physical correlates among older Latinos. Future studies might examine whether culturally relevant factors modify these associations

Physical exercise is associated with less neurocognitive impairment among HIV-infected adults.

Neurocognitive impairment (NCI) remains prevalent in HIV infection. Randomized trials have shown that physical exercise improves NCI in non-HIV-infected adults, but data on HIV-infected populations are limited. Community-dwelling HIV-infected participants (n = 335) completed a comprehensive neurocognitive battery that was utilized to define both global and domain-specific NCI. Participants were divided into "exercise" (n = 83) and "no exercise" (n = 252) groups based on whether they self-reported engaging in any activity that increased heart rate in the last 72&nbsp;h or not. We also measured and evaluated a series of potential confounding factors, including demographics, HIV disease characteristics, substance use and psychiatric comorbidities, and physical functioning. Lower rates of global NCI were observed among the exercise group (15.7&nbsp;%) as compared to those in the no exercise group (31.0&nbsp;%; p &lt; 0.01). A multivariable logistic regression controlling for potential confounds (i.e., education, AIDS status, current CD4+ lymphocyte count, self-reported physical function, current depression) showed that being in the exercise group remained significantly associated with lower global NCI (odds ratio = 2.63, p &lt; 0.05). Similar models of domain-specific NCI showed that exercise was associated with reduced impairment in working memory (p &lt; 0.05) and speed of information processing (p &lt; 0.05). The present findings suggest that HIV-infected adults who exercise are approximately half as likely to show NCI as compared to those who do not. Future longitudinal studies might be best suited to address causality, and intervention trials in HIV-infected individuals will determine whether exercise can prevent or ameliorate NCI in this population

COMT Val158Met Polymorphism, Cardiometabolic Risk, and Nadir CD4 Synergistically Increase Risk of Neurocognitive Impairment in Men Living With HIV.

ObjectiveThe Val allele of the Val158Met single-nucleotide polymorphism of the catechol-o-methyltransferase gene (COMT) results in faster metabolism and reduced bioavailability of dopamine (DA). Among persons living with HIV, Val carriers display neurocognitive deficits relative to Met carriers, presumably due to exacerbation of HIV-related depletion of DA. COMT may also impact neurocognition by modulating cardiometabolic function, which is often dysregulated among persons living with HIV. We examined the interaction of COMT, cardiometabolic risk, and nadir CD4 on neurocognitive impairment (NCI) among HIV+ men.MethodsThree hundred twenty-nine HIV+ men underwent COMT genotyping and neurocognitive and neuromedical assessments. Cohort-standardized z scores for body mass index, systolic blood pressure, glucose, triglycerides, and high-density lipoprotein cholesterol were averaged to derive a cardiometabolic risk score (CMRS). NCI was defined as demographically adjusted global deficit score of ≥0.5. Logistic regression modeled NCI as a function of COMT, CMRS, and their interaction, covarying for estimated premorbid function, race/ethnicity, and HIV-specific characteristics. Follow-up analysis included the 3-way interaction of COMT, CMRS, and nadir CD4.ResultsGenotypes were 81 (24.6%) Met/Met, 147 (44.7%) Val/Met, and 101 (30.7%) Val/Val. COMT interacted with CMRS (P = 0.02) such that higher CMRS increased risk of NCI among Val/Val [odds ratio (OR) = 2.13, P &lt; 0.01], but not Val/Met (OR = 0.93, P &gt; 0.05) or Met/Met (OR = 0.92, P &gt; 0.05) carriers. Among Val/Val, nadir CD4 moderated the effect of CMRS (P &lt; 0.01) such that higher CMRS increased likelihood of NCI only when nadir CD4 &lt;180.DiscussionResults suggest a tripartite model by which genetically driven low DA reserve, cardiometabolic dysfunction, and historical immunosuppression synergistically enhance risk of NCI among HIV+ men, possibly due to neuroinflammation and oxidative stress

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds.

ObjectiveThis study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB).MethodParticipants included healthy, primarily English-speaking Hispanic (n&nbsp;=&nbsp;93; Hispanic-English), primarily Spanish-speaking Hispanic (n&nbsp;=&nbsp;93; Hispanic-Spanish), and English speaking Non-Hispanic white (n&nbsp;=&nbsp;93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses.ResultsSpanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps&nbsp;&lt;&nbsp;.01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p&nbsp;=&nbsp;.001), processing speed (p&nbsp;=&nbsp;.003), and working memory (p&nbsp;&lt;&nbsp;.001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group.ConclusionsOn tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated