Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables

Abstract

Objective The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors utilizing the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. Method One-hundred-seventy adults (91 Black; 79 White), who participated in a multisite study were included (Age: M=56.4, SD=12.6; Education: M=13.7, SD=2.5; 50% male; Years post-stroke: 1–18; Stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically-corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the modified Rankin Scale. Results An independent samples t-test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63 SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. Conclusion We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences.

Association of sickle cell trait with measures of cognitive function and dementia in African Americans

“…The prevalence of CSVD and risk factors for CSVD are significantly higher among African Americans compared to non-Hispanic Whites [2]. This disparity exists even after adjusting for traditional dementia risk factors and relevant covariates [3,4]. Several studies have reported on the contribution of genetic variation, such as the APOE ε4 genotype, to the incidence and prevalence of dementia and cognitive decline in both African Americans and non-Hispanic Whites [[5], [6], [7]].…”

Neural and Genetic Bases for Human Ability Traits

“…Using such ability traits can facilitate neuropsychiatric diagnosis and treatment, as well as allow the prediction of individual risks. It can help understand contributors of different conditions, such as chronic pain (Alais et al, 2010;Vachon-Presseau et al, 2016), neurodevelopmental disorders (Barch et al, 2019), autism (Happé and Frith, 1996), stroke rehabilitation (Carlozzi et al, 2017;Johnson et al, 2017), Alzheimer's disease (Snyder et al, 2011), and other neuropsychiatric conditions (Hayden et al, 2018). While personality traits have been studied extensively (Gerlach et al, 2018), human ability, including behavioral and neurological function, is still underexplored.…”

Disability in Community-Dwelling Older Adults: Exploring the Role of Stroke and Dementia

“…13,[23][24][25] While researchers have suggested that blacks have shown poorer cognitive function following stroke, the combined contribution of stroke and dementia to race differences in disability is unknown. 26 In this context, we explore the relative impact of stroke and dementia with disability. We hypothesize that a person with both stroke and dementia will have greater disability than the sum of its parts.…”