WHICAPWashington

Heights/Hamilton Heights-Inwood Columbia Aging

Project

Jennifer J. Manly, PhDColumbia University Medical Center

jjm71@columbia.edu

Acknowledgements

• Funded in part by Grant R13AG030995-01A1 from the National Institute on Aging

• The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

CollaboratorsMaria GlymourChristopher WeissAdam BrickmanKaren SiedleckiRobert Heaton

Supported by• NIA R01 AG16206 (PI: Manly)• NIA P01 AG07232 (PI: Mayeux)

Lenny CedanoRaquel CaboYaakov SternRichard MayeuxNicole Schupf

INWOOD

WASHINGTON HEIGHTS

HAMILTON HEIGHTS• N = 2125 in 1992• Added 2174 in1999 to total 2801• Age 65 and older• Spanish or English speaking• Seen in home at 18 – 24 month intervals• Dx based on neuropsychological test battery,

medical & functional interview

0

10

20

30

40

50

Per

cen

t o

f co

ho

rt

Caucasian AfricanAmerican

Hispanic

PI: Richard Mayeux

Age-Specific Incidence of Alzheimer’s Disease

Annu

al a

ge-s

peci

fic in

cide

nce

Tang et al., 2001; Neurology 56: 49-56

Underlying all comparisons of test performance between racial/ethnic

groups is the fallacy imbedded in racial/ethnic classifications: that

there is a biological or genetic basis for race.

RACE

“ An inbreeding, geographically isolated population that differs in distinguishable physical traits from other members of the same species.”

Zuckerman, 1990; p. 1297

Hypertension & SES

• Research shows that the higher rates of hypertension among African Americans as compared to Whites “persists” after adjusting for traditional indicators of SES (e.g., years of education, income)

• Genes for hypertension unique to African Americans are being sought

Hypertension & SES

• Accounting for assets, debt, use of public assistance, and neighborhood-level indicators of income explains racial differences in hypertension Cooper & Kaufman, 1998; Kaufman et al., 1997

• Perceived discrimination and residential segregation perception of discrimination have significant associations with hypertension Krieger, 1999; Williams, 1997; Williams & Neighbors, 2001; Williams, Neighbors, & Jackson, 2003; Williams, Massing, Rosamond, Sorlie, & Tyroler, 1999; Wyatt et al., 2003

Race• Used as a proxy for assumed educational, socioeconomic,

biological, or behavioral differences • Diversity within ethnic groups:

– Educational– Linguistic– Geographic– Economic– Exposure to Mainstream culture

• Racial classification is fluid over time and place

DECONSTRUCTING RACE AND EDUCATION

• Assume these variables are proxies for more meaningful underlying factors

• Determine which aspects of the variable are expected to affect test performance– Premorbid– Change over time

• Determine relationship to test performance• Adjust for significant factors before interpreting

scores, regardless of race

MCI in an ethnically and educationally diverse cohort

• Most MCI studies are clinic-based Caucasian, well educated participants

• How can MCI criteria be operation among ethnically, linguistically, and educationally diverse elders?

• What implications do the use of robust norms in this diverse sample have on MCI prevalence and outcomes?

No significant ethnic differences in frequency of MCI

0

2

4

6

8

10

12

14

MCI with memoryimpairment

MCI with no memoryimpairment

White

Black

HispanicPerc

ent

Manly et al, Arch Neurol (2005)

Length of School Term

Proportion of variance in cognitive test scores explained by state of elementary education

Manly, Glymour, and Weiss (in preparation)

English Reading Level

Wide Range Achievement Test - reading subtest

I V Z J Q see red milk was

between cliff stalk gruntclarify residence urge rancid

conspiracy deny quarantine deteriorateregime beatify internecine regicidal

puerile factitious lucubrationepithalamion inefficacious synecdoche

Self-reported WRAT-3 years of education

estimate 0-3 4-6 7-8 9-12 13+ 0-3 3 8 5 11 4-6 5 6 11 1 7-8 2 2 2 16 3 9-12 2 9 30 40 13+ 1 3 40 40

READING LEVEL AND YEARS OF EDUCATION

ETHNICITY, GRADE, AND READING LEVEL

African-American

non-Hispanic

White

N 125 74reading level = actual grade 29% 47%reading level > actual grade 24% 35%reading level < actual grade 47% 18%

Reading ability accounts for ethnic group differences

Test

African American N = 192

White

N = 192

ANOVA

ANCOVA with

WRAT-3

Mean Mean F F Memory

SRT Total recall 39.8 43.5 12.9** 1.7 SRT Delayed recall 5.8 6.7 8.9* 0.7 Benton figure recognition 7.4 8.1 20.4** 2.5 Orientation

10 Items from MMSE 9.7 9.8 3.5 Abstract Reasoning

WAIS-R Similarities 12.0 16.0 34.8** 3.7 Identities/oddities total 14.6 15.1 10.8* 1.8

** p < .01; *** p < .001Manly et al, 2002, J Int Neuropsychol Soc 8: 341-348

Reading ability accounts for ethnic group differences

Test African American N = 192

White

N = 192

ANOVA

ANCOVA with

WRAT-3

Mean Mean F F Language

15-item Boston Naming 14.0 14.1 0.5 Letter fluency 9.9 12.2 31.8** 10.0* Category fluency 14.6 16.8 31.4** 0.8 BDAE Repetition 7.8 7.8 0.0 BDAE Comprehension 5.5 5.8 13.4** 3.2 Visuospatial skill

Rosen Drawing 2.6 3.0 30.0** 10.9* Benton Figure Matching 8.9 9.4 13.1** 3.4

* p < .05; ** p < .01Manly et al, 2002, J Int Neuropsychol Soc 8: 341-348

Determinants of cross-sectional language test performance

All models are adjusted for age and sex

***

***

***

***

*** ******

***

Literacy and Memory

Manly et al., JCEN 2003

Race, education, literacy, & incident ADRe

lativ

e Ri

sk

** p < .01; *** p < .001

***

***

***

***

**

Memory

Language

Speed

SRT-Total

SRT- Delayed recall

SRT- Delayed recog

Naming total

Letter Fluency

Category Fluency

Similarities

Repetition

BVRT recognition

Comprehension

BVRT Matching

Rosen

Identities/ Oddities

Color Trails 1

Color Trails 2

e1

e2

e3

e7

e8

e9

e10

e11

e12

e13

e14

e15

e6

e5

e4

Visual-spatial

Spanish Reading Level Word Accentuation Test

ACULLAABOGACIAANOMALOCELIBEALELIRABIAPATRIDAHUSARALEGORIAMANCHUDIAMETRO

MOARECONCAVOAMBARPUGILPOLIGAMOACMESILICEGRISUALBEDRIOCANONPIFANO

TACTILVOLATILDESCORTESDISCOLOBULGAROBALADIACOLITOCUPULA

Del Ser et al., 1997

Predicting Incident AD among Hispanic Immigrantsn = 670

Model 1 Model 1 Model 2 Model 3 Model 4

Variables in the Model

B p value

B p value

B p value B p value B p value

Age .103 .000 .106 .000 .103 .000 .107 .000 .106 .000

Sex .189 .352 .208 .307 .169 .410 .206 .330 .230 .280

Years of education -.073 .002 -.065 .009 -.051 .046 .033 .280 .038 .209

Dominican vs. other -.238 .242 -.110 .608 -.038 .865 .046 .840

Time in the US -1.225 .060 -1.055 .113 -.669 .350

Spanish Reading -.082 .000 -.081 .000

English Fluency .381 .140

Sensitivity and specificity of self-reported stroke

Sensitivity Specificity

All vascular territories 32.4 78.9

Large infarcts 51.5 78.1

Small infarcts 28.5 76.6

Cortical infarcts 40.0 76.3

Subcortical infarcts 33.1 77.3

Reitz et al., submitted

717 nondemented elders scanned225 persons had a brain infarct on MRI

Brickman et al., in press

Age, ethnicity, and relative WMH volume