Background and Objective:The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto-Rican older adults living in the Greater Boston Area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group, compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer’s Disease Neuroimaging Initiatives (ADNI) and National Alzheimer’s Coordinating Center (NACC) databases.Methods:BPRHS participants who underwent brain Magnetic Resonance Imaging (MRI) and cognitive testing were divided into four groups based on their HTN and T2D status: HTN-/T2D-, HTN+/T2D-, HTN-/T2D+ and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes and brain age based on T1-weighted MRI, and cognitive test scores. BPRHS results were then compared with non-Hispanic White and Hispanic participants from the ADNI and NACC databases.Results:The prevalence of HTN was almost twice (66.7% vs 38.7%) and T2D five times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D- group, compared to the HTN-/T2D- group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and GCS scores were observed in HTN+/T2D+ relative to HTN-/T2D-. MRI measures and MMSE from the HTN+/T2D+ BPRHS group resembled ADNI White progressive MCI participants, while the BPRHS HTN-/T2D- resembled stable MCI participants. The BPRHS was not significantly different from the ADNI+NACC Hispanic cohort on imaging or MMSE measures.Discussion:The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group, compared to non-Hispanic White adults in the same age range.
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