Objective To examine variability across multiple prospective cohort studies in level and rate of cognitive decline by race/ethnicity and years of education. Method To compare data across studies, we harmonized estimates of common latent factors representing overall or general cognitive performance, memory, and executive function derived from the: 1) Washington Heights, Hamilton Heights, Inwood Columbia Aging Project (N=4,115), 2) Spanish and English Neuropsychological Assessment Scales (N=525), 3) Duke Memory, Health, and Aging study (N=578), and 4) Neurocognitive Outcomes of Depression in the Elderly (N=585). We modeled cognitive change over age for cognitive outcomes by race, education, and study. We adjusted models for sex, dementia status, and study-specific characteristics. Results For baseline levels of overall cognitive performance, memory, and executive function, differences in race and education tended to be larger than between-study differences and consistent across studies. This pattern did not hold for rate of cognitive decline: effects of education and race/ethnicity on cognitive change were not consistently observed across studies, and when present were small, with racial/ethnic minorities and those with lower education declining at faster rates. Discussion In this diverse set of datasets, non-Hispanic whites and those with higher education had substantially higher baseline cognitive test scores. However, differences in the rate of cognitive decline by race/ethnicity and education did not follow this pattern. This study suggests that baseline test scores and longitudinal change have different determinants, and future studies to examine similarities and differences of causes of cognitive decline in racially/ethnically and educationally diverse older groups is needed.

In a national survey, 82% of U.S. neuropsychologists who offered services to Hispanics self-reported inadequate preparation to work with this population (Echemendia, Harris, Congett, Diaz, & Puente, 1997). The purpose of this paper is to improve the quality and accessibility of neuropsychological services for Hispanic people living in the United States by giving guidance for service delivery, training, and organizational policy. General guidance towards this end comes from professional ethics for psychologists and interpreters/translators, federal civil rights law, the International Test Commission, and the Office of Minority Health of the U.S. Department of Health and Human Services, among others. This guidance is specifically applied here to cover professional cultural and linguistic competence of neuropsychologists, psychometrists, interpreters, translators, and consultants; languages of evaluation; use of interpreters; evaluation of acculturation; test translation, adaptation, and interpretation; application of test norms; intervention issues; reimbursement; and organizational issues.

Quality of education appears to be more important than cerebrovascular risk factors in explaining cross-sectional differences in memory and EF performance between White and AA older adults. Further investigation is needed regarding the relative contribution of education quality and cerebrovascular risk factors to cognitive decline among ethnically/racially diverse older adults.

reassigned to reflect that support. As management of ''representation'' became unwieldy, and to avoid potential imbalances or slights, efforts toward ''representation'' were largely abandoned in favor of invitation based on expertise. In the end, panelists were chosen to reflect key perspectives that needed discussion or to contribute as a function of their demonstrated expertise in an area critical to the Summit. Finally, each of these panelists was allowed to invite one other participant, in the hopes of populating the Summit with trainees or early career professionals with a strong commitment to diversity issues. The overarching goal of the Summit was to develop a plan for the future of cross-cultural neuropsychology. Specific targets for discussion included the delineation of the proper use of ethnic norms, allocation of resources for research, scientific approaches to the study of multicultural neuropsychology, education and training, and the development and dissemination of products from the Summit. It was intended that the Summit would be an inspirational springboard from which many efforts would follow.

The recruitment of asymptomatic volunteers has been identified as a critical factor that is delaying development and validation of preventive therapies for Alzheimer’s disease (AD). Typical recruitment strategies involve the use of convenience samples or soliciting participation of older adults with a family history of AD from clinics and outreach efforts. However, high risk groups, such as ethnic/racial minorities, are traditionally less likely to be recruited for AD prevention studies, thus limiting the ability to generalize findings for a significant proportion of the aging population. A community-engagement approach was used to create a registry of 2,311 research-ready, healthy adult volunteers who reflect the ethnically diverse local community. Furthermore, the registry’s actual commitment to research was examined, through demonstrated participation rates in a clinical study. The approach had varying levels of success in establishing a large, diverse pool of individuals who are interested in participating in pharmacological prevention trials and meet criteria for primary prevention research trials designed to delay the onset of AD. Our efforts suggest that entry criteria for clinical trials need to be carefully considered to be inclusive of African Americans, and that sustained effort is needed to engage African Americans in pharmacological prevention approaches.

Objective To evaluate the association between the degree of response to placebo in migraine studies and the observed difference between drug and placebo across studies of preventative treatments for migraine. Methods A systematic review was performed using MEDLINE and the Cochrane Central Register of Controlled Clinical Trials from January 1988 to June 2019. Randomized, double-blind, parallel-group, placebo-controlled trials on oral or injection preventative treatments for migraine were included. Single- and multi-variable linear regression analyses were performed on the placebo-subtracted response rate (i.e. placebo responders subtracted from active responders), and the proportion of placebo responders. Fisher’s exact tests were performed on the level of placebo response and the success in meeting the study’s primary endpoint. Results After adjusting for route of administration and number of randomized subjects, there was a statistically significant association between the proportion of patients who were placebo responders and the placebo-subtracted response rate (b = −0.27, p = 0.02). There was a statistically significant difference in trial success rate (60%) between studies with ≤20% placebo responders and studies with > 30% placebo responders ( p = 0.03). Conclusion Considering the detrimental impact that high placebo response can have on clinical trials, it is imperative to find effective solutions to decrease the placebo response and increase assay sensitivity.

Background Understanding regional differences in cognitive performance is important for interpretation of data from large multinational clinical trials. Methods Data from Durham and Cabarrus Counties in North Carolina, U.S. and Tomsk, Russia (n=2,972) were evaluated. The Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (Trails B), CERAD Word List Memory Test delayed recall (WLM), and self-report ADCS Mail-In Cognitive Function Screening Instrument (MCFSI) were administered at each site. Multilevel modeling measured the variance explained by site and predictors of cognitive performance. Results Site differences accounted for 11% of the variation on the MoCA; 1.6% on Trails B; 1.7% on WLM; and 0.8% in MCFSI scores. Prior memory testing was significantly associated with WLM. Diabetes and stroke were significantly associated with Trails B and MCFSI. Conclusions Sources of variation include cultural differences, health conditions, and exposure to test stimuli. Findings highlight the importance of local norms to interpret test performance.

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