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Racism Tied to Later Life Cognitive Dysfunction

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It is common knowledge that racism, whether structural or personal, is detrimental to the well-being of the person who encounters it. It is unhealthy and contributes to ethnic inequality. New evidence suggests that experiences of racism are associated with cognitive decline later in life.

This was the main idea behind the two studies presented at the Alzheimer’s Association International Conference press conference.

“We know there are communities like Black African Americans and Hispanic Hispanics who are at greater risk of developing Alzheimer’s or other dementia,” said Carl Hill, Ph.D., who moderated the press conference. He pointed out that genetic and lifestyle factors associated with dementia only tell part of the story. “It’s important that science also explore the unique experiences of those at greater risk of developing dementia in our society,” said Hill, who is Alzheimer’s Association director for equity and inclusion.

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Racism, memory and cognition in middle-aged patients

Jennifer J. Manley, Ph.D., professor of neuropsychology at Columbia University in New York, presented a study of racism experiences and memory scores among a very diverse middle-aged cohort.

“There is little understanding of how multiple levels of racism, including intrapersonal, institutional and structural racism, affect cognitive aging and the risk of dementia,” Manley said at a press conference.

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Among the 1,095 participants, 19.5% were non-Hispanic white (61% female, mean age 57), 26.0% were non-Hispanic black (63% female, mean age 56), 32.3% were English-speaking Hispanic (66% female). , mean age 56 years). median age 50), and 21.2% were Hispanic Latino (68% female, median age 58).

The researchers used the Everyday Discrimination (ED) Scale to measure individual racism experiences, the Severe Discrimination (MD) Scale to measure institutional racism experiences, and the Census Block Group Residential Segregation for an individual’s parents to measure residential segregation. Outcome measures included a numerical range to measure attention and working memory, and a selective recall test to measure episodic memory.

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The study found a clear link between racism and cognition. “The relationship of interpersonal racism to memory corresponds to 3 years of chronological age and was driven by black non-Hispanic participants. A strong association was then established between institutional racism and memory scores among non-Hispanic black participants, such that each reported civil rights violation was consistent with the impact of approximately 4.5 years of age on memory,” Manley said.

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“The bottom line is that our results show that exposure to racism is a significant driver of memory function later in life, even in middle age, and especially for blacks,” Manley added.

The results should alert doctors to the complexities of racism and its consequences. “Healthcare professionals need to be aware that many of the accumulated risks are historical and structural and beyond human control. Perhaps more importantly, the medical system itself can perpetuate discriminatory experiences that contribute to poor health,” Manley said.

Latin American issues

Also at the press conference, Adriana Perez, Ph.D., highlighted the challenges Hispanic Latinos face in healthcare. Only 5-7% of nurses are Hispanic. “The same can be said for physicians and clinical psychologists … when you look at the really important positions on brain health equity, you see that we are not represented there,” said Perez, associate professor and senior fellow at the Pennsylvania university. School of Nursing in Philadelphia.

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She also pointed out that Hispanic representation in clinical trials is very low, although surveys conducted by the Alzheimer’s Association show that this population values ​​medical science and is willing to participate. In fact, 85% said they would participate if invited. The problem is that many clinical trial announcements state that participants must speak English. Even many bilingual Hispanics may be put off by this wording: “This is a message that you are not invited. That’s how it’s perceived,” Perez said.

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Racism and cognition in old age

At a press conference, Kristen George, Ph.D., presented the results of a study of people over 90 years of age. “Racial differences in dementia have been well characterized, especially among people aged 65 and over, but we don’t know very much. about the oldest elderly people aged 90 and over. This group is one of the fastest growing populations and is becoming more diverse,” said George, assistant professor of epidemiology at the University of California, Davis.

The group included 445 Asian, Black, Hispanic, White, and multi-racial members of Kaiser Permanente Northern California, with a median age of 92.7 years. They used the Basic Experiences of Discrimination Scale to assess discrimination.

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The researchers divided them into three groups based on gender, race, and responses to a 10-point scale. Class 1 included mostly white males who reported discrimination in the workplace, with an average of two severe cases of discrimination. Class 2 consisted of white women and non-whites who reported little or no discrimination, with a median of 0. Class 3 included all non-white participants and reported an average of four instances of discrimination.

Using class 2 as a benchmark, executive function was better in class 1 individuals (beta = 0.28; 95% CI, 0.03-0.52), but there was no significant difference between class 3 and class 2. Class 1 had better basic semantic memory than class 2 (beta = 0.33; 95% CI, 0.07–0.58), and class 3 patients performed significantly worse than class 2 (beta = –0.24; 95% CI, -0.48 to -0.00). There were no differences between groups in baseline verbal or episodic memory.

Perez, Manley, George and Hill have not disclosed any related financial relationships.

This article originally appeared on MDedge.com, part of the Medscape professional network.

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