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1 Social Support is Associated with Better Memory Performance among Hispanic/Latino, but not Non-Hispanic White Older Adults
- Abbey M Hamlin, Jordana Breton, Nazareth Ortega, Joaquin Urquiza-Perez, Lauren Eisenstat, Megan Perry, Thaha Hossain, Sanya Kotian, Alexandra L Clark
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 317-318
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Objective:
Hispanic/Latino (H/L) older adults are at greater risk of developing Alzheimer’s disease and related dementias compared to non-Hispanic whites (NHW), and there is an urgent need to identify important factors that may help prevent and/or reduce age-related cognitive health disparities. Positive psychosocial factors, such as social support, may protect against cognitive impairment and decline. However, recent research has highlighted that the effect of social support on cognitive outcomes may differ across racial/ethnic groups. Given the emphasis placed on family relationships and support in H/L culture, the current study sought to clarify whether H/L ethnicity moderated the association between social support and cognitive functioning in a well-characterized sample of community-dwelling older adults residing in Texas.
Participants and Methods:Participants included 766 NHW and 817 H/L (predominantly Mexican American) older adults (Mage = 66.25 ±8.64) without dementia enrolled in the Health and Aging Brain Study-Health Disparities. Participants completed study questionnaires and a comprehensive neuropsychological battery. Perceived social support was measured using the total sum score from the 12-item abbreviated version of the Interpersonal Support Evaluation List. Episodic memory performance was operationalized as the z-score composite of the immediate and delayed recall totals from the Spanish English Verbal Learning Test and the Weschler Memory Scale (WMS)-III Logical Memory 1 and 2. Executive functioning was operationalized as the z-score composite of scores from the WMS-III Digit Span, Verbal Fluency (FAS), and Trails B. Analyses of covariance were used to explore racial/ethnic group differences in self-reported levels of social support. Multiple linear regression models examined (1) ethnicity x social support interactions on cognition, and (2) ethnicity-stratified social support and cognition associations. Covariates included age, education, sex, yearly income, and depressive symptoms.
Results:H/L older adults reported less perceived social support compared to NHWs (F = 41.16, p < .001). There were no significant ethnicity x social support interactions on episodic memory (ß = 0.04, p = .53) or executive functioning (ß = 0.004, p = .95). However, stratified models revealed that more social support was associated with better memory performance in H/Ls (ß = 0.08, p = .01), but not in NHWs (ß = 0.0004, p = .99). No significant associations between social support and executive functioning were observed amongst H/Ls (ß = -0.01, p = .60) or NHWs (ß = 0.04, p = .29).
Conclusions:Although H/Ls reported lower levels of social support relative to NHWs, we observed that social support was linked to better memory performance within the H/L group only. Results suggest that culturally tailored interventions which encourage strong interpersonal relationships and caring for family could enhance social support in H/Ls and thus help to prevent memory decline. Future work should focus on the development of assessment measures that better characterize unique cultural elements of social support within H/Ls, such as multigenerational households, and explore the direct effects of social support on brain metrics.
5 Poorer Memory Outcomes are Observed in Underinsured Latino Older Adults with Metabolic Syndrome
- Jordana Breton, Abbey M Hamlin, Nazareth Ortega, Joaquin Urquiza-Perez, Thaha Hossain, Megan Perry, Lauren Eisenstat, Sanya Kotian, Alexandra L Clark
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 787-788
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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.
28 Social Support, APOE Genotype, and Memory Associations in a Community-Based Sample of Older Adults in Texas
- Nazareth Ortega, Abbey M Hamlin, Jordana Breton, Lauren Eisenstat, Joaquin Urquiza-Perez, Alexandra L. Clark
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 441-442
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Objective:
The apolipoprotein E (APOE) gene has been identified as a major risk factor for the development of Alzheimer’s disease in late life. Research has shown that APOE e4 allele carriers demonstrate poorer memory performance and accelerated cognitive decline relative to non-carriers, and there is a need to identify potential factors of resiliency against the negative effects of e4 on cognition. Social support may represent one potential mechanism given that higher levels of social support have been linked to better cognitive and functional outcomes in older adults. Thus, the current study sought to examine whether social support moderates the relationship between APOE e4 status and subjective and objective memory performance in a large community-based sample of Hispanic/Latino (H/L) and Non-Hispanic White (NHW) older adults residing in Texas.
Participants and Methods:Participants included 1,564 (H/L = 808, NHW = 756) older adults (mean age = 66.36±8.68) without dementia that had enrolled in the Health and Aging Brain Study-Health Disparities. Participants completed study questionnaires and a comprehensive neuropsychological battery. Apolipoprotein e4 status (e4 carriers vs. non-carriers) was determined by possession of at least one e4 allele. Perceived social support was measured using the total score from the abbreviated 12-item version of the Interpersonal Support Evaluation List. Objective memory performance was assessed using a z-score composite of Story A and B from the Weschler Memory Scale (WMS)-III and immediate and delayed recall trials from the Spanish-English Verbal Learning Test. Subjective memory was assessed using the total score from the Subject Memory Complaints Questionnaire. Race stratified multiple linear regression models, controlling for age, sex, and years of education, examined APOE e4 positivity x social support interactions on subjective and objective memory performance.
Results:There was a significant APOE e4 genotype x social support interaction on objective memory performance (ß = -1.10, p = 0.003) in H/Ls such that higher levels of social support were associated with better memory performance in non-e4 carriers (ß = 0.14, p < .001), but not in e4 carriers (ß = -0.13, p = 0.9). In contrast, no significant APOE e4 status x social support interaction was observed on subjective memory (ß = -0.39, p = 0.35) in H/Ls. Finally, results revealed no significant APOE e4 genotype x social support interactions on subjective memory (ß = 0.14 p = 0.77) or objective memory (ß = 0.67, p = 0.11) performance in NHWs. Conclusions: Findings revealed that social support did not mitigate against the negative effects of e4 on subjective and objective memory performance in H/Ls or NHWs. However, results demonstrate that higher levels of social support are associated with better objective, but not subjective memory performance in H/Ls without the e4 genotype. These findings suggest that social support may protect against cognitive decline and enhance cognitive reserve in non-e4 carriers. Future studies should explore other potential factors of resiliency (e.g., diet, exercise) and examine the association between genetic risk and social support on neural markers (e.g., cortical thinning, hippocampal atrophy).