Psychological well-being and cognitive aging in Black, Native American, and White Alzheimer’s Disease Research Center participants

Psychological well-being is associated with cognition in later life but has not been examined across diverse populations—including minoritized communities at disproportionately high risk of dementia. Further, most previous work has not been able to examine links between specific facets of psychological well-being and performance within distinct cognitive domains that can capture subclinical impairment. Using a well-characterized sample followed through enrollment in an NIH-funded Alzheimer’s Disease Center, we sought to test these associations within three racial groups at baseline. Participants were N = 529 cognitively unimpaired Black, American Indian/Alaska Native (AI/AN), and white middle-aged and older adults (mean age = 63.6, SD = 8.1, range = 45–88 years) enrolled in the Wisconsin Alzheimer’s Disease Research Center’s Clinical Core. Predictors included validated NIH Toolbox Emotion Battery scales assessing positive affect, general life satisfaction, and meaning and purpose. Outcomes included performance on widely used tests of executive functioning and episodic memory. We conducted race-stratified regression models to assess within-group relationships. Black and AI/AN participants reported lower life satisfaction than white participants. Racial disparities were not observed for positive affect or meaning and purpose scores. Across groups, life satisfaction predicted better executive functioning. Similar associations were observed for positive affect in Black and AI/AN samples but not among whites. In general, well-being measures were not related to performance on tests of episodic memory. Our results highlight well-being as a potentially important determinant of late-life cognitive health, particularly executive functioning, that is modifiable if older adults are connected with appropriate resources and supports. Further, psychological well-being may represent a potent target for brain health interventions tailored for Black and Native communities

Learning from Transmasculine Experiences with Health Care: Tangible Inlets for Reducing Health Disparities through Patient-Provider Relationships

Purpose: We examined health care experiences of transmasculine young adults to clarify factors contributing to mistrust in the health care system and identify tangible and modifiable means to address health disparities through improved patient-provider interactions. Thematic analysis highlights patterns within historical relationships between medical models and transmasculine embodiment, and provides guidance for health care clinicians, researchers, and policy makers to deliver competent services for transgender and gender diverse (TGD) individuals. Methods: The study team used qualitative methodology guided by interpretive phenomenological analysis. Semistructured interviews with 12 participants who self-identified as transmasculine were conducted, transcribed, and coded thematically. Results: Participants were a community sample of 12 young adults 18-35 years of age (M=23, standard deviation=3.74), who self-identified as transmasculine. Three participants identified as a racial/ethnic minority. Participants were highly educated, with most completing at least some college. The superordinate thematic domain Perspectives on Health Care emerged, under which three subthemes were nested: (1) an essentialist, binary medical model is inaccurate and oppressive, (2) consequences of medicalizing gender (i.e., gender as a diagnosis), and (3) recommendations to improve health care. Conclusions: Qualitative analysis revealed specific ways in which the relationship between transmasculine individuals and current health care systems are fraught with difficulties, including the impact of stigma, gatekeeping, and inaccuracies, in current diagnostic criteria. Participants shared lived experiences and offered innovative ideas to improve health care delivery, such as challenging socialized biases, increased education, and immersion in TGD communities to advocate for change in research, practice, and policy

Addressing the disparities in dementia risk, early detection and care in Latino populations: Highlights from the Second Latinos and Alzheimer's Symposium

The Alzheimer's Association hosted the second Latinos & Alzheimer's Symposium in May 2021. Due to the COVID-19 pandemic, the meeting was held online over 2 days, with virtual presentations, discussions, mentoring sessions, and posters. The Latino population in the United States is projected to have the steepest increase in Alzheimer's disease (AD) in the next 40 years, compared to other ethnic groups. Latinos have increased risk for AD and other dementias, limited access to quality care, and are severely underrepresented in AD and dementia research and clinical trials. The symposium highlighted developments in AD research with Latino populations, including advances in AD biomarkers, and novel cognitive assessments for Spanish-speaking populations, as well as the need to effectively recruit and retain Latinos in clinical research, and how best to deliver health-care services and to aid caregivers of Latinos living with AD

Childhood and adulthood traumatic events differentially associate with cognitive aging among Black and White elders in the Health and Retirement Study

BackgroundModifiable sociocontextual factors powerfully shape ADRD risk, and demonstrably contribute to well‐established racial disparities in cognitive aging. Stressful experiences occurring across the lifespan associate with brain aging and poor cognitive outcomes. However, the importance of timing and even type of stressor remains understudied. We examined relationships between childhood and adulthood traumatic events and cognition among non‐Hispanic Black and White older adults in the Health and Retirement Study (HRS).MethodThe sample included non‐demented adults (N=5,725) aged 65+ with lifetime stress data and complete cognitive testing at the 2006/08, 2010/12, and/or 2014/16 waves. Trauma measures included childhood (0‐11), and adulthood (0‐7) traumatic event counts. Outcomes included global cognition, immediate recall, and delayed recall (Telephone Interview for Cognitive Status). Each exposure‐outcome pair was investigated in separate linear mixed effect models including baseline trauma count, a quadratic trauma term to test for non‐linear relationships, and subject‐specific random intercept. Omnibus Likelihood Ratio Tests (LRT) were conducted to determine if number of traumatic events associated overall with each cognitive outcome. The sample was stratified by race before analysis.ResultBlack participants (N=651) were younger and reported less formal education than White participants (N=5,074). Number of traumatic events in adulthood did not vary by race, but Black participants reported slightly fewer childhood traumas (Table 1) than Whites. Among Whites, childhood traumas associated with poorer global cognition scores but traumas in adulthood showed very modest positive associations across cognitive domains. Among Black participants, no association between childhood trauma and later‐life cognition was observed. A significant non‐linear term for traumatic events indicated cross‐domain cognitive detriment associated with high exposure to adulthood trauma (Table 2; Figure 1).ConclusionAverage exposure to traumas (eg., physical abuse, life‐threatening illness) was low, and in both Black and White older adults, some limited exposure to traumatic events during adulthood predicted modest cognitive benefit. Black HRS participants reporting many traumatic events during adulthood, but not childhood, showed dysfunction in global cognition and recall. Findings highlight importance of adverse events across the full life course, potential threshold effects and co‐occuring chronic stress conditions, and a need to identify resources that buffer impacts of trauma on biology and personal environment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171142/1/alz056419.pd

Lifetime stressful experiences and cognitive performance in African American and white older adults: New evidence from a population‐based cohort

BackgroundGrowing evidence suggests that modifiable sociocontextual factors powerfully shape health including risk for Alzheimer’s disease and related dementias (ADRD), and contribute substantially to well‐established racial disparities in cognitive aging. Stressful experiences cluster and accumulate across the lifespan, plausibly impacting brain health, but cognitive effects of lifetime adversity across diverse populations remain underexplored. We examined relationships between lifetime stressful events and cognition among African American and White older adults in the Health and Retirement Study (HRS).MethodThe study sample included non‐demented adults (N=8,222) aged 60 and older who provided cognitive and lifetime stress data at the 2006/08 and 2010/12 HRS waves. Cognitive outcomes included performance on a test of global cognition (Telephone Interview for Cognitive Status) and its immediate and delayed recall subscales. The key predictor of interest was a Lifetime Stress index score (sample range=0‐11 experiences). Mixed‐effects regression models assessed associations of lifetime stress with each cognitive outcome. Polynomial and three‐way interaction models explored potential (1) non‐linear associations between stress and cognition, and (2) moderation of those relationships by race.ResultAfrican Americans (N=1,015) were younger (M=71.7, SD=6.8) than whites (M=72.2, SD=6.3) and reported fewer years of education (p<0.001). Reported number of stressful life events reported (M=1.61, SD=1.45) did not vary by race. In adjusted models (Table 1, Model 2), a significant stress quadratic revealed that relationships with global cognition (p<0.001) and delayed recall (p=0.01) were non‐linear. Modification by African American race (Table 1, Model 3; Figure 1) was observed for global cognition (p=0.01) but not recall subscales (immediate: p=0.10; delayed: p=0.45).ConclusionWe found that lifetime stress is associated with poorer later‐life cognitive function; however, detriment is observed only at high levels of stress. African American and White HRS participants report very few stressful life events on average, but African Americans reporting many stressors showed exacerbated stressor‐associated dysfunction in global cognition. Our findings from this large, population‐based sample reaffirm the role for stress and stress‐adjacent experiences in cognitive aging, particularly among communities facing disproportionate ADRD burden. Expanding community‐specific, lifecourse‐based research and intervention strategies is a necessary next step toward understanding and mitigating disparity through targeted resource placement and stakeholder partnerships.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163909/1/alz046422.pd

Association between military service and Alzheimers disease neuropathology at autopsy.

INTRODUCTION: Anti-amyloid therapies are at the forefront of efforts to treat Alzheimers disease (AD). Identifying amyloid risk factors may aid screening and intervention strategies. While veterans face increased exposure to risk factors, whether they face a greater neuropathologic amyloid burden is not well understood. METHODS: Male decedents donating to two Alzheimers Disease Research Center (ADRC) brain banks from 1986 to 2018 with categorized neuritic plaque density and neurofibrillary tangles (n&nbsp;=&nbsp;597) were included. Using generalized ordered logistic regression we modeled each outcomes association with military history adjusting for age and death year. RESULTS: Having served in the military (60% of sample) is associated with post mortem neuritic amyloid plaque (for each comparison of higher to lower C scores OR&nbsp;=&nbsp;1.26; 95% confidence interval [CI]&nbsp;=&nbsp;1.06-1.49) and tau pathology (B score OR&nbsp;=&nbsp;1.10; 95% CI&nbsp;=&nbsp;1.08-1.12). DISCUSSION: This is the first study, to our knowledge, finding increased levels of verified AD neuropathology in those with military service. Targeted veteran AD therapies is a pressing need

Self-reported health behaviors and longitudinal cognitive performance in late middle age: Results from the Wisconsin Registry for Alzheimer's Prevention.

BackgroundStudies have suggested associations between self-reported engagement in health behaviors and reduced risk of cognitive decline. Most studies explore these relationships using one health behavior, often cross-sectionally or with dementia as the outcome. In this study, we explored whether several individual self-reported health behaviors were associated with cognitive decline when considered simultaneously, using data from the Wisconsin Registry for Alzheimer's Prevention (WRAP), an Alzheimer's disease risk-enriched cohort who were non-demented and in late midlife at baseline.MethodWe analyzed longitudinal cognitive data from 828 participants in WRAP, with a mean age at baseline cognitive assessment of 57 (range = 36-78, sd = 6.8) and an average of 6.3 years (standard deviation = 1.9, range = 2-10) of follow-up. The primary outcome was a multi-domain cognitive composite, and secondary outcomes were immediate/delayed memory and executive function composites. Predictors of interest were self-reported measures of physical activity, cognitive activity, adherence to a Mediterranean-style diet (MIND), and interactions with each other and age. We conducted linear mixed effects analyses within an Information-theoretic (IT) model averaging (MA) approach on a set of models including covariates and combinations of these 2- and 3-way interactions. The IT approach was selected due to the large number of interactions of interest and to avoid pitfalls of traditional model selection approaches.ResultsModel-averaged results identified no significant self-reported health behavior*age interactions in relationship to the primary composite outcome. In secondary outcomes, higher MIND diet scores associated with slower decline in executive function. Men showed faster decline than women on delayed memory, independent of health behaviors. There were no other significant interactions among any other health behaviors and cognitive trajectories.ConclusionsWhen multiple covariates and health behaviors were considered simultaneously, there were limited weak associations with cognitive decline in this age range. These results may be explained alone or in combination by three alternative explanations: 1) the range of cognitive decline is in middle age is too small to observe relationships with health behaviors, 2) the putative associations of these health behaviors on cognition may not be robust in this age range, or 3) the self-reported measures of the health behaviors may not be optimal for predicting cognitive decline. More study may be needed that incorporates sensitive measures of health behaviors, AD biomarker profiles, and/or other disease comorbidities

Plasma Aβ42/40 and cognitive variability are associated with cognitive function in Black Americans: Findings from the AA‐FAIM cohort

Abstract Introduction It is critical to develop more inclusive Alzheimer's disease (AD) research protocols to ensure that historically excluded groups are included in preclinical research and have access to timely diagnosis and treatment. If validated in racialized groups, plasma AD biomarkers and measures of subtle cognitive dysfunction could provide avenues to expand diversity in preclinical AD research. We sought to evaluate the utility of two easily obtained, low‐burden disease markers, plasma amyloid beta (Aβ)42/40, and intra‐individual cognitive variability (IICV), to predict concurrent and longitudinal cognitive performance in a sample of Black adults. Methods Two hundred fifty‐seven Black participants enrolled in the African Americans Fighting Alzheimer's in Midlife (AA‐FAIM) study underwent at least one cognitive assessment visit; a subset of n = 235 had plasma samples. Baseline IICV was calculated as the standard deviation across participants’ z scores on five cognitive measures: Rey Auditory Verbal Learning Test Delayed Recall, Trail Making Test Parts A and B (Trails A and B), and Boston Naming Test. Using mixed effects regression models, we compared concurrent and longitudinal models to baseline plasma Aβ42/40 or IICV by age interactions. PrecivityAD assays quantified baseline plasma Aβ42/40. Results IICV was associated with concurrent/baseline performance on several outcomes but did not modify associations between age and cognitive decline. In contrast, plasma Aβ42/40 was unrelated to baseline cognitive performance, but a pattern emerged in interactions with age in longitudinal models of Trails A and B and Rey Auditory Verbal Learning Test total learning trials. Although not significant after correcting for multiple comparisons, low Aβ42/40 was associated with faster cognitive declines over time. Discussion Our results are promising as they extend existing findings to an Black American sample using low‐cost, low‐burden methods that can be implemented outside of a research center, thus supporting efforts for inclusive AD biomarker research