The effect of race and health-related factors on naming and memory. The MacArthur Studies of Successful Aging

Analyzing direct effects of education level and estimated IQ between cognitively intact Mexican Americans and Non-Hispanic whites on a confrontational naming task

Confrontational naming is widely used in diagnosing neurodegenerative disorders like MCI and dementia, and previous research indicates that healthy Non-Hispanic Whites outperform Hispanics in such tasks. However, understanding the factors contributing to score differences among ethnic groups remains limited. This study focuses on cognitively intact Mexican Americans and Non-Hispanic White older adults from the TARCC Hispanic Cohort project. Hierarchical regression analyses reveal that sex, age, ethnicity, education level, and estimated IQ significantly predict performance on the Boston Naming Test (BNT). Notably, education level and estimated IQ more strongly influence BNT performance in Mexican Americans than in Non-Hispanic Whites. When controlling for education level, estimated IQ has a more pronounced impact on BNT performance in aging Mexican Americans compared to Non-Hispanic Whites. Conversely, after controlling for estimated IQ, the influence of education level is weaker for Mexican Americans than Non-Hispanic Whites. These findings emphasize the need for careful evaluation of confrontational naming task scores in diverse ethnic groups, emphasizing the critical role of education and estimated IQ in understanding performance disparities.

Assessment of cross-cultural measurement invariance of the NIH toolbox fluid cognition measures between Jamaicans and African-Americans

The NIH Toolbox Cognitive Battery (NIHTB-CB) was developed as a common-metric, computerized cognitive screener for research. Although extensively normed and validated in Americans of different ethnicities, there is little data on how generalizable such results would be when used outside of the United States. The objective of this study was to assess measurement invariance (MI) of the NIHTB-CB across Jamaican and African-American samples and determine appropriateness of comparisons across groups. Multi-group confirmatory factor analyses using a single-factor model were conducted using five tests of fluid cognitive abilities from the NIHTB-CB, which assess working memory, episodic memory, processing speed, and executive function. MI was tested sequentially for configural, metric and scalar invariance. 125 Jamaican and 154 American adults of African descent were included. The Jamaican mean age was 31.6 ± 8.6 years (57% males) compared to 43.5 ± 15.5 years (25% males) for the African-American group. The Jamaicans had on average 11.3 ± 2.7 years of education compared to 13.9 ± 2.6 years for the African-Americans. We found metric and configural invariance across both samples but not scalar invariance. These findings suggest that the single factor emerging from the NIHTB-CB measures the same construct, i.e. fluid cognitive ability, in both groups and hence the battery is appropriate for assessments within cultures. However, lack of scalar invariance indicates that direct cross-cultural comparisons of performance levels should be interpreted with caution, also suggesting that U.S. normative standards are not generalizable to the Jamaican population.

Boston Naming Test: Lose the Noose

OBJECTIVE

Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation.

METHOD

Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA.

RESULTS

Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance.

CONCLUSIONS

Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly

Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer's disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.

Correlates of Life Satisfaction Among Middle-Aged and Older Black Adults

BACKGROUND

This study examines satisfaction across life domains (condition of the home, city of residence, daily life/leisure, family life, current financial situation, total household income, health, and life as a whole) among Black adults. The study also explores the association between satisfaction in each life domain and sociodemographic, personality, and mental/physical health measures.

METHODS

A community-dwelling sample of Black adults (n = 93, age range = 55-80) residing in the Tampa, FL area, completed a life satisfaction scale and measures of sociodemographic factors, personality, and mental/physical health between October 2014 and June 2016.

RESULTS

Better life satisfaction was observed in the oldest-old (80+) compared with the middle-aged (55-64; p < .05). Less education, less financial strain, lower depressive symptoms, and better self-rated physical health were associated with higher satisfaction although the pattern of results varied by domain.

CONCLUSIONS

Our findings suggest that the evaluation of life satisfaction domains may be a useful approach for identifying specific individual needs, which may inform age-friendly community initiatives.

Group differences in normal neuropsychological test performance for older non-Hispanic White and Black/African American adults

OBJECTIVE

Although researchers have documented the influence of cultural factors on neuropsychological test performance, few studies have examined the distribution of test scores among neurologically healthy older adults from different ethnic groups. The objective of this study was to determine whether there are group differences in neuropsychological test score distributions with ethnicity-specific norms for non-Hispanic White and Black/African American older adults.

METHOD

Participants from the National Alzheimer's Coordinating Center were selected if they were not diagnosed with dementia within 5 years (Mage = 75.26, SDage = 6.98; Meducation = 15.70, SDeducation = 2.91). Groups were formed based on self-identified ethnicity of White (n = 5,311) or Black/African American (n = 1,098). All participants completed neuropsychological testing, including the Mini Mental State Exam, Logical Memory Immediate and Delayed, Digit Span Forward and Backward, Trail Making Test A & B, Animal Naming, Vegetable Naming, Digit Symbol, and Boston Naming Test.

RESULTS

Based on combined ethnicity norms, the scores of Black participants were overrepresented in the below-average and low-average clinical ranges, and the scores of White participants were overrepresented in the high-average and superior clinical ranges for all 11 neuropsychological measures. When group specific norms were used, the unbalanced pattern of score categorization was no longer present for any of the neuropsychological measures.

CONCLUSIONS

These findings emphasize the importance of developing and using ethnically and culturally appropriate neuropsychological test norms as well as the risk of interpreting some Black individual's scores as below average when they likely are not. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Greater Disease Burden, Greater Risk? Exploring Cognitive Change and Health Status Among Older Blacks

Objective: The objective of study is to examine the relationships between health status and changes in cognition over time among middle to older aged Blacks. Method: Data come from the Baltimore Study of Black Aging-Patterns of Cognitive Aging. At baseline, 602 Black participants, ranging from ages 48 to 95 years, were enrolled. At follow-up, approximately 3 years later, 450 participants were re-interviewed. Results: After accounting for baseline cognition, age, sex, and education, a greater number of health conditions was associated with slower perceptual speed (b = -5.099, p = .022). Average peak expiratory flow was also associated with improvements in working memory (b = 0.029, p = .019) and perceptual speed (b = 0.026, p = .026), controlling for model covariates. Discussion: Study findings demonstrate that greater disease burden is associated with declines in specific fluid cognitive abilities in middle to later life among Blacks. This finding highlights the importance of reducing health disparities that disproportionately affect Blacks.

The association between educational parameters and a cognitive screening measure in older blacks

ABSTRACTBackground:To expand on prior literature by examining how various education parameters (performance-based reading literacy, years of education, and self-rated quality of education) relate to a cognitive screening measure's total and subscale scores of specific cognitive abilities.

METHODS

Black adults (age range: 55-86) were administered self-rated items years of education and quality of education, and a measure of performance-based reading literacy. The Mini-Mental State Examination (MMSE) was used to screen for overall cognitive functioning as well as performance on specific cognitive abilities.

RESULTS

Sixty-nine percent of the sample had reading grade levels that were less than their reported years of education. Lower years of education and worse reading literacy are associated with poorer MMSE performance, particularly on the attention and calculation subscales.

CONCLUSIONS

Years of education, a commonly used measure for education, may not be reflective of Black adults' educational experiences/qualities. Thus, it is important to account for the unique educational experiences of adults that could influence their MMSE performance. Incorporating quality and quantity of education will provide a more comprehensive understanding of the individual's performance on cognitive measures, specifically as it relates to sociocultural differences.

Performance discrepancies on the Boston Naming Test in African-American and non-Hispanic White American young adults

The Boston Naming Test (BNT) is one of the most commonly used naming measures in neuropsychology. Although research in the older adult population has shown that African-American (AA) adults perform more poorly on the BNT than non-Hispanic White American (WA) adults, these findings have yet to be replicated in younger adults. The BNT and measures of word reading (WJ-Letter Word ID) and vocabulary (Wechsler Abbreviated Scale of Intelligence Vocabulary) were administered to 50 WA and 33 AA young adults. Performance was age-normed based on published norms and transformed into z-scores. Despite being matched on age, gender, SES, and level of education, the AA group performed more poorly on the BNT (z = - 1.01(1.09)) than the WA group (z = - .28(.92)), t(104) = 3.44, p < .01, d = 0.73. AAs (18%) were more likely to perform in the impaired range than WAs (4%) when impairment cutoff was z-score≤ - 2. Healthy AA young adults are more likely to perform poorly on the BNT despite vocabulary and word reading being well within normal limits. Average BNT performance in both groups were at least one z-score lower than average vocabulary z-scores. Clinicians should interpret poor scores on the BNT with caution, and within the context of individual vocabulary or word reading performance.

The Impact of Desegregation on Cognition among Older African Americans

One of the single most influential factors on current and future cognitive functioning is educational attainment. We examined the influence of educational desegregation on cognitive performance using Horn’s Gf-Gc theory among older African Americans. The data on 197 African Americans included school attendance (desegregated [DS] or segregated [SS]) and the number of years they attended desegregated schools. Using measures of fluid (inductive reasoning and spatial ability) and crystallized (number concept and vocabulary) ability to assess cognition, the results showed that the DS group had significantly higher mean cognitive scores compared to the SS group. After controlling for age, gender, years of education, and years in desegregated schools, however, we found no difference between the DS and SS groups on measures of number concept, inductive reasoning, and general fluid and crystallized abilities but found differences for measures of vocabulary and spatial ability. The results were discussed in relation to differences in schooling and other potential influences over the life course.

Alzheimer's disease in African Americans: risk factors and challenges for the future

As the US elderly population continues to expand rapidly, Alzheimer's disease poses a major and increasing public health challenge, and older African Americans may be disproportionately burdened by the disease. Although African Americans were generally underincluded in previous research studies, new and growing evidence suggests that they may be at increased risk of the disease and that they differ from the non-Hispanic white population in risk factors and disease manifestation. This article offers an overview of the challenges of Alzheimer's disease in African Americans, including diagnosis issues, disparities in risk factors and clinical presentation of disease, and community-based recommendations to enhance research with this population.

The Multidimensional Influence of Acculturation on Digit Symbol-Coding and Wisconsin Card Sorting Test in Hispanics

OBJECTIVE

The purpose of the current study was to evaluate the relative contribution of acculturation to two tests of nonverbal test performance in Hispanics.

METHOD

This study compared 40 Hispanic and 20 non-Hispanic whites on Digit Symbol-Coding (DSC) and the Wisconsin Card Sorting Test (WCST) and evaluated the relative contribution of the various acculturation components to cognitive test performance in the Hispanic group.

RESULTS

Hispanics performed significantly worse on DSC and WCST relative to non-Hispanic whites. Multiple regressions conducted within the Hispanic group revealed that language use uniquely accounted for 11.0% of the variance on the DSC, 18.8% of the variance on WCST categories completed, and 13.0% of the variance in perseverative errors on the WCST. Additionally, years of education in the United States uniquely accounted for 14.9% of the variance in DSC.

CONCLUSIONS

The significant impact of acculturation on DSC and WCST lends support that nonverbal cognitive tests are not necessarily culture free. The differential contribution of acculturation proxies highlights the importance of considering these separate components when interpreting performance on neuropsychological tests in clinical and research settings. Factors, such as the country where education was received, may in fact be more meaningful information than the years of education of education attained. Thus, acculturation should be considered an important factor in any cognitive evaluation of culturally diverse individuals.

The Relationship Between Expressive Vocabulary Knowledge and Reading Skills for Adult Struggling Readers

This study examined expressive vocabulary and its relationship to reading skills for 232 native English-speaking adults who read between the third- and fifth-grade levels. The Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 2001) was used to measure expressive vocabulary. Participants scored lower than the normative sample of adults on all aspects of the test; they had fewer spontaneously correct answers, and were not helped by stimulus or phonemic cues. Hierarchical regression analyses revealed that expressive vocabulary accounted for significant variance in both reading comprehension and exception word reading, but not for general word reading or nonword reading.

Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study

OBJECTIVE

To examine whether observed differences in dementia rates between black and white older people living in the community could be explained by measures of socioeconomic status (income, financial adequacy, education, and literacy) and health related factors.

DESIGN

Prospective cohort study.

SETTING

General community from two clinic sites in the United States (Pittsburgh, Pennsylvania and Memphis, Tennessee).

PARTICIPANTS

2457 older people (mean age 73.6 years; 1019 (41.5%) black; 1233 (50.2%) women), dementia-free at baseline, in the Health, Aging, and Body Composition study.

MAIN OUTCOME MEASURE

Dementia was determined over 12 years (ending January 2011) by prescribed dementia drugs, hospital records, and decline in global cognitive scores. The influence of socioeconomic status and health related factors on dementia rates was examined in a series of Cox proportional hazard models in which these variables were added sequentially in covariate blocks.

RESULTS

Over follow-up, 449 (18.3%) participants developed dementia. Black participants were more likely than white participants to develop dementia (211 (20.7%) v 238 (16.6%), P<0.001; unadjusted hazard ratio 1.44, 95% confidence interval 1.20 to 1.74). The hazard ratio lessened somewhat after adjustment for demographics, apolipoprotein E e4, comorbidities, and lifestyle factors (1.37, 1.12 to 1.67) but was greatly reduced and no longer statistically significant when socioeconomic status was added (1.09, 0.87 to 1.37).

CONCLUSION

These findings suggest that differences in the burden of risk factors, especially socioeconomic status, may contribute to the higher rates of dementia seen among black compared with white older people. Strategies aimed at reducing these disparities may favorably affect the incidence of dementia.

"I'm still raring to go": successful aging among lesbian, gay, bisexual, and transgender older adults

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for "traditional success" characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: "surviving and thriving" and "working at it." A small number was "ailing": not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.

Personality as a Source of Individual Differences in Cognition among Older African Americans

Previous research suggests that demographic factors are important correlates of cognitive functioning in African Americans; however, less attention has been given to the influence of personality. The present study explored how dimensions and facets of personality predicted individual variability in cognition in a sample of older African Americans from the Baltimore Study of Black Aging. Cognition was assessed by verbal learning and attention/working memory measures. Personality was measured by the NEO Personality Inventory. Linear regressions controlling for demographic factors showed that Neuroticism, Openness, and Agreeableness were significant regression predictors of cognitive performance. Individual facets of all five personality dimensions were also associated with cognitive performance. These findings suggest personality is important in understanding variability in cognition among older African Americans.

Race differences in intellectual control beliefs and cognitive functioning

BACKGROUND/STUDY CONTEXT: The current study examined the relationship between intellectual control and cognition and related the results to everyday problem solving in a mixed ethnicity sample of 35% African American and 65% Caucasian elders.

METHODS

Participants completed the Personality in Intellectual Aging Contexts Inventory (PIC; Lachman et al., 1982 , Journal of Research in Personality, 16, 485-501), Everyday Cognition Battery (ECB; Allaire & Marsiske, 1999 , Psychology & Aging, 14, 627-644; 2002 , Psychology & Aging, 17, 101-115), and a battery of basic cognitive ability tests assessing memory, inductive reasoning, and verbal meaning.

RESULTS

Results indicated that African Americans had significantly lower intellectual control beliefs relative to Caucasian older adults. Regression models suggested that relationship between control beliefs and cognition was moderated by education and race. Decomposing the interactions with simple slope analysis revealed that across cognitive abilities, better cognitive performance was related to higher control beliefs in African Americans with at least 13 years of education. A similar relationship was also found in Caucasian elders with lower education.

CONCLUSION

African American elders' reaching a higher level of education may provide a basis for which individual differences in intellectual control beliefs are activated and thereby more strongly associated with cognitive performance.

Diversity and disparity in dementia: the impact of ethnoracial differences in Alzheimer disease

Debate exists regarding differences in the prevalence of Alzheimer disease (AD) in African Americans and Hispanics in the United States, with some evidence suggesting that the prevalence of AD may be considerably higher in these groups than in non-Hispanic whites. Despite this possible disparity, patients of minority ethnoracial groups often receive delayed diagnosis or inadequate treatment for dementia. This review investigates these disparities by conceptualizing the dementia disease process as a product of both biological and cultural factors. Ethnoracial differences in biological risk factors, such as genetics and cardiovascular disease, may help to explain disparities in the incidence and prevalence of AD, whereas race-specific cultural factors may impact diagnosis and treatment. Cultural factors include differences in perceptions about what is normal aging and what is not, lack of adequate access to medical care, and issues of trust between minority groups and the medical establishment. The diagnosis of AD in diverse populations may also be complicated by racial biases inherent in cognitive screening tools widely used by clinicians, but controlling for literacy level or using savings scores in psychometric analyses has the potential to mitigate these biases. We also suggest that emerging biomarker-based diagnostic tools may be useful in further characterizing diverse populations with AD. Recognizing the gap in communication that exists between minority communities and the medical research community, we propose that education and outreach are a critical next step in the effort to understand AD as it relates to diverse populations.

Explaining differences in episodic memory performance among older African Americans and Whites: the roles of factors related to cognitive reserve and test bias

Older African Americans tend to perform poorly in comparison with older Whites on episodic memory tests. Observed group differences may reflect some combination of biological differences, measurement bias, and other confounding factors that differ across groups. Cognitive reserve refers to the hypothesis that factors, such as years of education, cognitive activity, and socioeconomic status, promote brain resilience in the face of pathological threats to brain integrity in late life. Educational quality, measured by reading test performance, has been postulated as an important aspect of cognitive reserve. Previous studies have not concurrently evaluated test bias and other explanations for observed differences between older African Americans and Whites. We combined data from two studies to address this question. We analyzed data from 273 African American and 720 White older adults. We assessed DIF using an item response theory/ordinal logistic regression approach. DIF and factors associated with cognitive reserve did not explain the relationship between race, and age- and sex-adjusted episodic memory test performance. However, reading level did explain this relationship. The results reinforce the importance of considering education quality, as measured by reading level, when assessing cognition among diverse older adults.

The relationship between education level and mini-mental state examination domains among older Mexican Americans

To study the effect of education and language of response at the interview on performance in the Mini-Mental State Examination (MMSE) domains, we studied 2861 Mexican Americans aged 65 and older from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) followed from 1993 to 1994 until 2004 to 2005. The MMSE was examined as total score (0-30) or divided into 2 global domains: (1) no-memory (score 0-24): Orientation, attention, and language; and (2) memory (score 0-6): working and delayed memory. Mean age and total MMSE were 72.7 years and 24.6 at baseline, and 81.7 years and 20.5 at 11 years of follow-up. Spanish-speaking participants had less education (4.1 vs 7.4 years, P < .0001), they had significantly higher adjusted mean scores for memory, no-memory, and total MMSE compared with English-speaking participants. In multivariate longitudinal analyses, participants with more years of education performed better than those with less education, especially in total MMSE and no-memory domain. Spanish-speaking participants with 4 to 6 years of education had higher memory scores than those speaking English (estimate 0.40, standard error [SE] = 0.14, P < .001), 7 to 11 (estimate 0.27, standard error = 0.13, P < .01) or 12+ (estimate 0.44, standard error = 0.13, P < .001). Results suggest that cultural factors and variables related to preferred language use determined variations in MMSE performance. Because the memory domain of the MMSE is less affected by education, it may be used along with other cognitive tests for early detection of cognitive decline in older populations with low education.

Histories of social engagement and adult cognition: midlife in the U.S. study

OBJECTIVES

To evaluate whether social contacts, support, and social strain/conflict are related to executive function and memory abilities in middle-age and older adults.

METHODS

Longitudinal data on social contacts, support, and strain/conflict were examined in relation to executive function and memory at ages 35-85 years using data from the national Midlife in the U.S. (MIDUS) study. Age-related differences in patterns of association were also examined.

RESULTS

Regression analyses, controlling for age, sex, race, education, chronic health conditions, and health behaviors, revealed significant positive associations between histories of greater social contacts and support and both executive function and episodic memory, whereas declines in social contacts were negatively associated with both outcomes. Greater average reported frequency of social exchanges characterized by strain or conflict was negatively associated with executive function but not episodic memory. Patterns were generally consistent across different age groups; where differences were seen, associations were stronger in younger age group.

DISCUSSION

Positive and negative aspects of social relationships are related to cognition throughout adulthood, consistent with the hypothesis that social factors have life-long influences on cognition. Positive and negative aspects of social engagement may thus be important factors to consider in relation to efforts to promote optimal cognitive development and cognitive aging.

Race-related cognitive test bias in the active study: a mimic model approach

The present study investigated evidence for race-related test bias in cognitive measures used in the baseline assessment of the ACTIVE clinical trial. Test bias against African Americans has been documented in both cognitive aging and early life span studies. Despite significant mean performance differences, Multiple Indicators Multiple Causes (MIMIC) models suggested most differences were at the construct level. There was little evidence that specific measures put either group at particular advantage or disadvantage and little evidence of cognitive test bias in this sample. Small group differences in education, cognitive status, and health suggest positive selection may have attenuated possible biases.

Cardiovascular Health and Education as Sources of Individual Variability in Cognitive Aging Among African Americans

Objective: To examine the interrelated effects of cardiovascular health, education, and cognitive functioning in African Americans. Method: The present study utilized data from the Baltimore Study of Black Aging to examine whether (a) cardiovascular health and educational attainment predicted cognitive functioning, after controlling for age, and (b) there was an interaction between cardiovascular health and education in predicting cognitive functioning. Results: Using hierarchical regression analyses, results showed education was significant for all cognitive measures; however, cardiovascular health was significant for only three. Discussion: These findings suggest that although self-reported cardiovascular health contributes to variability in late life cognition in African Americans, education is a more universal predictor that should be further examined.

Education in time: cohort differences in educational attainment in African-American twins

OBJECTIVES

Educational opportunities for African-Americans expanded throughout the 20(th) century. Twin pairs are an informative population in which to examine changes in educational attainment because each twin has the same parents and childhood socioeconomic status. We hypothesized that correlation in educational attainment of older twin pairs would be higher compared to younger twin pairs reflecting changes in educational access over time and potentially reflecting a "ceiling effect" associated with Jim Crow laws and discrimination.

METHODOLOGY AND PRINCIPAL FINDINGS

We used data from 211 same-sex twin pairs (98 identical, 113 fraternal) in the Carolina African-American Twin Study of Aging who were identified through birth records. Participants completed an in-person interview. The twins were predominantly female (61%), with a mean age of 50 years (SD = 0.5). We found that older age groups had a stronger intra-twin correlation of attained educational level. Further analysis across strata revealed a trend across zygosity, with identical twins demonstrating more similar educational attainment levels than did their fraternal twin counterparts, suggesting a genetic influence.

DISCUSSION

These findings suggest that as educational opportunities broadened in the 20th century, African-Americans gained access to educational opportunities that better matched their individual abilities.

Differential item functioning of the Boston Naming Test in cognitively normal African American and Caucasian older adults

Scores on the Boston Naming Test (BNT) are frequently lower for African American when compared with Caucasian adults. Although demographically based norms can mitigate the impact of this discrepancy on the likelihood of erroneous diagnostic impressions, a growing consensus suggests that group norms do not sufficiently address or advance our understanding of the underlying psychometric and sociocultural factors that lead to between-group score discrepancies. Using item response theory and methods to detect differential item functioning (DIF), the current investigation moves beyond comparisons of the summed total score to examine whether the conditional probability of responding correctly to individual BNT items differs between African American and Caucasian adults. Participants included 670 adults age 52 and older who took part in Mayo's Older Americans and Older African Americans Normative Studies. Under a two-parameter logistic item response theory framework and after correction for the false discovery rate, 12 items where shown to demonstrate DIF. Of these 12 items, 6 ("dominoes," "escalator," "muzzle," "latch," "tripod," and "palette") were also identified in additional analyses using hierarchical logistic regression models and represent the strongest evidence for race/ethnicity-based DIF. These findings afford a finer characterization of the psychometric properties of the BNT and expand our understanding of between-group performance.

An examination of dedifferentiation in cognition among African-American older adults

The structure and organization of cognitive abilities has been examined across the life span. The current analysis had three specific aims: (1) test the factor structure of a broad cognitive ability battery across three age groups; (2) examine differences in the pattern of factor covariation across age groups; and (3) examine the pattern of factor mean differences across age groups. A sample of 512 older African Americans (mean age = 66.6 years, 25.4% male) from the Baltimore Study of Black Aging was administered a battery of cognitive tests assessing the domains of perceptual speed, verbal memory, inductive reasoning, vocabulary, and working memory. Factor models were estimated separately in middle-age adults (50-59 years, n = 107), young-old adults (60-69 years, n = 198), and old-old adults (70-79 years, n = 207). There was loading invariance across the three age groups that suggests that the selected tests measured cognition similarly across age. There was no evidence of dedifferentiation across increasingly older age groups. Factor mean differences were observed with the middle-age group having significantly higher factor means than the young-old and old-old groups; however, there was only one factor mean difference between the young-old and the old-old groups. The results suggest that a pattern of dedifferentiation of cognitive abilities does not exist within this sample of older African Americans and that the 60-69 year age range may be a critical period for cognitive decline in this population.

Item analysis of three Spanish naming tests: a cross-cultural investigation

Neuropsychological evaluations conducted in the United States and abroad commonly include the use of tests translated from English to Spanish. The use of translated naming tests for evaluating predominately Spanish-speakers has recently been challenged on the grounds that translating test items may compromise a test's construct validity. The Texas Spanish Naming Test (TNT) has been developed in Spanish specifically for use with Spanish-speakers; however, it is unlikely patients from diverse Spanish-speaking geographical regions will perform uniformly on a naming test. The present study evaluated and compared the internal consistency and patterns of item-difficulty and -discrimination for the TNT and two commonly used translated naming tests in three countries (i.e., United States, Colombia, Spain). Two hundred fifty two subjects (136 demented, 116 nondemented) across three countries were administered the TNT, Modified Boston Naming Test-Spanish, and the naming subtest from the CERAD. The TNT demonstrated superior internal consistency to its counterparts, a superior item difficulty pattern than the CERAD naming test, and a superior item discrimination pattern than the MBNT-S across countries. Overall, all three Spanish naming tests differentiated nondemented and moderately demented individuals, but the results suggest the items of the TNT are most appropriate to use with Spanish-speakers. Preliminary normative data for the three tests examined in each country are provided.

Are comparisons the answer to understanding behavioral aspects of aging in racial and ethnic groups?

The knowledge gained from studying diverse populations should help to address inequities and prepare us to deal with the needs of the increasing number of older minorities in this country. At the same time, research that is not properly conducted threatens to lead us astray and misconstrue relationships and outcomes related to behavioral aspects of aging. In this article, we propose that simple comparisons between groups are neither necessary nor sufficient to advance our understanding of ethnic minorities. We discuss common pitfalls conducted in group-differences research, including a specific treatment on the issue of statistical power issues. Our goal is to encourage the use of multiple methodological designs in the study of issues related to racial and ethnic minorities by demonstrating some of the advantages of lesser employed approaches.

The Relationship Between Reported Problems Falling Asleep and Cognition Among African American Elderly

This study examined the relationship between elders' cognitive performance and self-reported trouble falling asleep. Analyses were conducted on 174 older independently living, community dwelling African Americans ( M age = 72.74; range = 65 to 90). Cognitive performance was measured using the Mini-Mental State Examination, Forward Digit Span task, Backward Digit Span task, Alpha Span task, and California Verbal Learning Test. Results suggested that individuals who reported trouble falling asleep tended to perform significantly worse than individuals who did not report trouble falling asleep on measures tapping short-term memory and working memory after controlling for age, education, gender, depression, and current health. These results demonstrate that a self-report of sleep difficulty may be a unique predictor of cognitive performance.

Development of the Texas Spanish Naming Test: a test for Spanish speakers

Neuropsychological assessment of Spanish speakers often involves translated versions of English measures, with limited validation data and potential bias due to cultural, educational, and linguistic differences. The Texas Spanish Naming Test (TNT), a 30-item confrontation naming test, was developed for Spanish speakers by systematically selecting culturally salient words. In a sample of 85 minimally educated Spanish speakers, the TNT demonstrated good internal consistency and convergent validity, and showed greater sensitivity than a translated version of the popular Boston Naming Test. Results support the clinical utility of the TNT when dementia among Spanish speakers is suspected.

Characterizing and explaining differences in cognitive test performance between african american and European American older adults

The present study examined differences in cognitive performance of African American and European American older adults on cognitive and intellectual measures, and the extent to which literacy status or reading level was useful in explaining these group differences. African American elders performed more poorly than European American elders on 12 of 13 cognitive tests administered, p < .05. After controlling for reading level achievement, differences in performance became nonsignificant for 5 of these 12 tests. Nonetheless, some differences persisted, suggesting that other potential mediators of race differences remain to be explored in future research.

Spontaneous production and use of mnemonic strategies in older adults

Mnemonic strategy use in older adults has been measured a number of ways, and although strategy measurement has received considerable attention, little work has been done to compare various types of subjective strategy reporting. The authors compared self-generated and endorsed strategies for memory tasks in a sample of 85 African-American and Caucasian older adults and investigated demographic characteristics related to each strategy measurement and the relationship between strategy use and memory performance. Across memory measures, significantly more strategies were endorsed than self-generated. Race, favoring Caucasians, was the most salient demographic predictor of mnemonic strategy usage. Although strategic behavior was associated with ability performance on most memory measures, specific strategies for optimal performance were identified for number and story recall only. Findings highlight the importance of measuring both self-generated and endorsed strategies and confirm previous work on the relationship between strategy use and memory performance.

Examining the association between lung functioning and cognitive performance in African American adults

The current study examined the extent to which pulmonary functioning, as measured by average peak expiratory flow, was related to performance on seven cognitive measures. Analyses were conducted on a sample of 396 African American adults ranging in age from 22 to 89 years.

RESULTS

Lung functioning was not uniquely associated with cognitive performance in the younger adults, though it emerged as a significant predictor of individual differences in performance on the Telephone Interview of Cognitive Status even after controlling for age, education, and smoking history. Biobehavioral assessments such as the one presented here appear to provide important new insights into the sources of individual differences in cognition observed in this understudied population.

Disparities Among Older Adults in Measures of Cognitive Function by Race or Ethnicity

This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.

A cross-cultural study with culture fair normative indications on WAIS-III Digit Symbol-Incidental Learning

The WAIS-III Digit Symbol-Incidental Learning optional procedure, including Pairing and Free Recall, was administered to a southern African sample (N=68, age range 19-30), which was stratified for ethnicity in association with language of origin (white English first language versus black African first language), educational level (Grade 12 and Graduate), and quality of education (advantaged and disadvantaged). ('African language' is the term used to denote the indigenous languages of black populations in southern Africa). Results yielded no significant differences for ethnicity/language of origin, level or quality of education, indicating that Digit Symbol-Incidental Learning may be a relatively culture independent task with utility as a neuropsychological screening instrument. Broad normative guidelines are provided for diagnostic purposes, and comparisons are made with available norms.

Relationships among health factors and everyday problem solving in african americans

This study examined whether measures of health status enhance the prediction of performance on everyday problem solving in adult African Americans. The sample consisted of 209 community-dwelling African American adults with a mean age of 66.82 years (SD=7.95). The following variables were included in the analysis: Everyday Problems Test (EPT), summary index of chronic illnesses (cardiovascular disease, hypertension, arthritis, stroke, and diabetes), self-rated health (current health, health in the past month, health compared with others, health compared with 5 years ago), and demographic information. Using hierarchical regression and follow-up communality analysis, the authors found that the number of chronic illnesses and self-rated health as compared with 5 years prior were significant and unique predictors of performance on the EPT but did not account for all of the demographic-related variance. The results indicate that health indices contribute to the variability in everyday cognition in this understudied population.

Memory self-efficacy and memory performance among black and white elders

BACKGROUND

The ability to differentiate between normal functioning and pathologic changes in cognitive aging will be enhanced by descriptive studies providing data from diverse samples of older adults.

METHODS

In this study, demographics, depression, health, memory self-efficacy, and metamemory were studied in relation to the memory performance of Black and White American older adults. Community-living adults participated in face-to-face interviews in their apartments or homes. Trained registered nurse interviewers administered all structured questionnaires (subjective) and performance tests (objective), including the Rivermead Behavioural Memory Test. Descriptive statistics, independent sample t-tests, Pearson correlations, and hierarchical regression were used in the analyses.

RESULTS

The sample consisted of 89 Black and 83 White adults (mean age, 76.52 years), and their Mini-Mental State Examination scores were in the nonimpaired range. The memory self-efficacy scores of the entire sample were low (M = 31.95 +/- 18.20). The Black elders scored lower on memory self-efficacy and memory performance. Memory self-efficacy predicted memory performance in the White group (r [83] =.41; p < or =.05), but the correlation for the Black group was nonsignificant (r [89] =.16). However, when the entire sample was combined for the regression analyses, the relation was significant (r [173] =.30; p < or =.05). Age, education, and memory self-efficacy accounted for 13% of the variance in memory performance.

CONCLUSIONS

Objective and subjective memory scores were decreased, and both measures provided insight into the participants' everyday memory function. The sample had low confidence in their memory ability, and this negatively influenced their everyday memory performance. The recruitment of minority elders into cognitive aging studies will continue to challenge researchers.

Life expectancy with cognitive impairment in the older population of the United States

OBJECTIVES

This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS

Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS

The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION

As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

Black and white men at risk for memory impairment

BACKGROUND

Blacks are under-represented in government-funded research. Epidemiological data indicate that morbidity and mortality in the United States are higher in Blacks than in Whites.

OBJECTIVE

To examine memory performance in a sample of Black and White healthy men 70 years of age and older.

METHOD

Sixty-nine (24 Black, 45 White) men participated in a study of memory performance. All individuals lived either in private homes or subsidized high-rise apartments.

RESULTS

Black men had higher anxiety about their memories, used fewer internal and external memory strategies, and had less confidence and less understanding of their everyday memory than White men. Based on their depression scores, more Black men (35%) were at risk for depression than White men (10%). Even though there were no differences in the numbers of men who lived alone, White men were five times more likely to be married and live with a spouse (27 vs. 5).

CONCLUSION

In this sample of Black and White men, there were no differences in actual memory performance, but significant differences were found in the subjective aspects of memory evaluation.