Cited by 340Dementia and Cognitive Impairment ResearchHealth disparities and outcomesCognitive Abilities and Testing

Cognitive Aging in Black and White Americans: Cognition, Cognitive Decline, and Incidence of Alzheimer Disease Dementia

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Weuve, Jennifer, Barnes, Lisa L., Mendes de Leon, Carlos F., Rajan, Kumar B., Beck, Todd, Aggarwal, Neelum T., Hebert, Liesi E., Bennett, David A. +2 more·2018·Epidemiology

Abstract

BACKGROUND: US-based studies have reported that older blacks perform worse than older whites on cognitive tests and have higher risk of Alzheimer disease dementia (AD). It is unclear whether these findings reflect differences in cognitive decline. METHODS: The Chicago Health and Aging Project followed individuals, 65+ years old (64% black, 36% white), for up to 18 years. Participants underwent triennial cognitive assessments; stratified randomized samples underwent assessments for AD. We compared black and white participants' cognitive performance, cognitive decline rate (N = 7,735), and AD incidence (N = 2,144), adjusting for age and sex. RESULTS: Black participants performed worse than white participants on the cognitive tests; 441 participants developed AD. Black participants' incident AD risk was twice that of whites (RR = 1.9; 95% CI, 1.4, 2.7), with 58 excess cases/1,000 occurring among blacks (95% CI, 28, 88). Among noncarriers of APOE ε4, blacks had 2.3 times the AD risk (95% CI, 1.5, 3.6), but among carriers, race was not associated with risk (RR = 1.1; 95% CI, 0.6, 2.0; Pinteraction = 0.05). However, cognitive decline was not faster among blacks: the black-white difference in 5-year change in global cognitive score was 0.007 standard unit (95% CI, -0.034, 0.047). Years of education accounted for a sizable portion of racial disparities in cognitive level and AD risk, in analyses using a counterfactual approach. CONCLUSIONS: The higher risk of AD among blacks may stem from lower level of cognitive test performance persisting throughout the observation period rather than faster rate of late-life cognitive decline. Disparities in educational attainment may contribute to these performance disparities. See video abstract at, http://links.lww.com/EDE/B299.

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  • These health conditions disproportionately affect Black and Hispanic populations and are believed to explain much of the elevated risk of dementia among Black and Hispanic populations.

    “These health conditions, which disproportionately affect Black and Hispanic populations, are believed to explain much of the elevated risk of dementia among Black and Hispanic populations.”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [82]

    The Results (Alzheimer’s disease and all-cause dementia; page unavailable) report higher Alzheimer’s disease risk among Black than White participants. The paper does not establish that the health conditions referred to in the claim disproportionately affect Black and Hispanic populations or explain much of either population’s elevated dementia risk; its study compares Black and White Americans. (LLM, conf=0.85)

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  • Studies of the association between APOE-e4 and Alzheimer's dementia in Black and Hispanic populations have had inconsistent results.

    “Studies of this association in Black and Hispanic populations have had inconsistent results.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [88]

    The Discussion reports differing findings on APOE ε4 and Alzheimer dementia risk among Black participants: this study found no increased risk, while a genome-wide association study found increased risk. The paper does not discuss whether findings in Hispanic populations have been inconsistent; its mention of Hispanics appears in a reference title, not in that discussion. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • These health conditions, which disproportionately affect Black and Hispanic populations, are believed to explain much of the elevated risk of dementia among Black and Hispanic populations.

    “These health conditions, which disproportionately affect Black and Hispanic populations, are believed to explain much of the elevated risk of dementia among Black and Hispanic populations.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [88]

    The Results section reports higher Alzheimer disease risk among Black participants than White participants. The paper does not establish that health conditions explain much of that difference, and its study does not assess Hispanic populations. The Discussion instead considers differences in cognitive level as a possible explanation. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Some studies found that having the APOE-e4 allele did not increase Alzheimer's risk among Blacks, while other studies found that it significantly increased risk.

    “For example, some have found that having the e4 allele did not increase risk among Blacks, [80][81][82] while other studies have found that it significantly increased risk.[83][84][85][86]”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [82]

  • The influence of the APOE-e4 allele on Alzheimer's risk may be stronger for White Americans than Black Americans.

    “the influence of the APOE-e4 allele on Alzheimer's risk may be stronger for White Americans than Black Americans”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [82]

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Research works printed but not linked: 2

  1. [17]Bienias JL Kott PS Evans DA Application of the delete-a-group jackknife variance estimator to analyses of data from a complex longitudinal survey Proceedings of the Annual Meeting of the American Statistical Association - Section on Survey Research Methods [CD-ROM] 2003 539 544
  2. [18]Bienias JL Kott PS Beck TL Evans DA Incorporating multiple observations into logistic regression models of incident disease Proceedings of the Annual Meeting of the American Statistical Association - Section on Survey Research Methods [CD-ROM] 2005 2767 2774

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Authors
Weuve, J., Barnes, L. L., Mendes de Leon, C. F., Rajan, K. B., Beck, T., Aggarwal, N. T., Hebert, L. E., Bennett, D. A., Wilson, R. S., & Evans, D. A.
Affiliations
  • Boston University (US)
  • Rush University Medical Center (US)
Corresponding author
Weuve, Jennifer
Venue
Epidemiology
Published
2018-01
Volume
29
Issue
1
Pages
151-159
ISSN
1044-3983 (ISSN-L)
OpenAlex
W2753252511
Cited by
340
References
56
Citations by year
2026: 30 · 2025: 39 · 2024: 42 · 2023: 51 · 2022: 54 · 2021: 65 · 2020: 30 · 2019: 22 · 2018: 6 · 2017: 1
FWCI
13.26
Type
journal article
Language
en
Open access
Locations
  • Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (R01AG011101, R01AG051635)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
Keywords
cognitive aging, racial disparities, Alzheimer's disease, cognitive decline, African Americans, White Americans, APOE ε4, years of schooling, counterfactual analysis, dementia risk, Chicago Health and Aging Project
MeSH terms
Cognitive Aging, Aged, Aged, 80 and over, Alzheimer Disease, Black or African American, Chicago, Cognition, Female, Humans, Longitudinal Studies, Male, Neuropsychological Tests, Risk Factors, United States, Incidence, White People, Apolipoprotein E4, Cognitive Dysfunction

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