Trends in Memory Problems and Race/Ethnicity in the National Health and Examination Survey, 1999-2014

Abstract

Background: Little data exist to describe serial population-level trends in cognitive impairment– especially among minority communities. Because memory problems are among the first warning signs of cogni­tive impairment, they provide a potential method for monitoring changes in cogni­tive health at the population level. This exploratory study aimed to: 1) estimate prevalence of memory problems among US residents by race/ethnicity, age category; and 2) examine whether racial/ethnic dif­ferences in subjective cognitive concerns (memory problems) varied across recent time periods.Design and Setting: Serial cross-sectional analysis of self-reported data from the National Health and Examination Survey (NHANES), 1999-2014.Participants: 20,585 participants aged ≥45 years during 1999-2014, who reported race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Latino/Hispanic.Measurements: The outcome of interest was subjective cognitive concerns, identi­fied as self-reported memory problems. The frequencies of memory problems were examined for each 4-year period, across racial/ethnic groups.Results: In adjusted analyses, compared with older (aged ³65 years) NHWs, dispari­ties in subjective cognitive concerns were observed for older Latinos for most periods (range of AOR: 1.43 – 2.01, P<.05). Ad­ditionally, Latinos without a high school education had significantly higher odds of reporting memory problems than NHW in multiple periods (range of AOR: 1.95 – 2.17, P<.005), while Latino high school graduates did not. There were no significant changes in racial/ethnic differences in sub­jective cognitive concerns over time.Conclusions: The prevalence of sub­jective cognitive concerns across time periods points to a need to engage patients – particularly older and less-educated Latinos – about warning signs for cogni­tive impairment. The impact of education on subjective cognitive concerns in older Latinos may be related to acculturation and warrant further investigation. Ethn Dis. 2019;29(3):525-534; doi:10.18865/ ed.29.3.525

Age Patterns in Self-Reported Cognitive Impairment Among Older Latino Subgroups and Non-Latino Whites in the United States, 1997–2018: Implications for Public Health Policy

“…These findings varied between midlife (age 45 and older), and late-life (65 and older) Latinos, with older adults (14.8%–21.5%) exhibiting a higher burden of self-reported cognitive impairment than their younger counterparts (7.9%–11.2%). Although the age categories differ somewhat from prior studies using the NHIS, these results corroborate that older Latinos are at an increased risk of self-reported cognitive impairment compared to Whites ( Casillas et al, 2019 ).…”

“…Thus, self-reported cognitive decline may represent one of the earliest noticeable indicators for decreased cognitive functioning ( Alzheimer’s Association, 2021 ; Jessen et al, 2014 ), as individuals who self-report cognitive decline are more likely to progress to cognitive impairment and dementia compared to those without SCD ( Donovan et al, 2014 ; Jessen et al, 2010 ; Mitchell et al, 2014 ; Wolfsgruber et al, 2016 ). Missed or delayed diagnoses of cognitive decline impede the ability to identify and treat individuals; conversely, early diagnosis of cognitive decline can facilitate the identification of treatable cases, and provide timely and accurate information to such individuals ( Casillas et al, 2019 ; Luo et al, 2018 ). Studies on self-reported cognitive decline may then offer an opportunity for interventions to identify and modify potentially treatable contributors to cognitive decline ( Livingston et al, 2017 ; Mukadam et al, 2019 ), so that appropriate resources and prevention efforts can be tailored to minority and immigrant groups to prevent or delay the onset of disease ( Dallo et al, 2021 ).…”

“…Additional research from the National Health and Nutrition Examination Survey (1999–2014) examined age patterns and period effects of self-reported cognitive impairment among non-Latino White, non-Latino Black, and Latino adults aged 45 and older ( Casillas et al, 2019 ). The results showed that Latinos (8.1%–11.2%) exhibited a significantly higher prevalence of self-reported cognitive impairment over the study period (except for 2003–2006) than non-Latino Whites (4.1%–6.1%).…”

Culture and Cognition—the Association Between Acculturation and Self-reported Memory Problems Among Middle-aged and Older Latinos in the National Health and Nutrition Examination Survey (NHANES), 1999 to 2014

“…The methods are previously described in an NHANES study of the prevalence of US memory problems by race/ethnicity and age category for 20,585 participants ≥ 45 years during 1999-2014. 5 The outcome for this analysis was the response to the question: "Are you limited in any way because of difficulty remembering or because you experienced periods of confusion?" (yes/no).…”

Multiculturalism and reported cognitive change in Parkinson’s disease

“…However, the literature comparing racial groups within specific societies or residents of different world regions suggests that culture and subjective appraisal of cognition and function may be related. Findings are mixed with respect to difficulties with iADLs (Hackett et al, 2020; Tappen et al, 2010), and SCD (Borelli et al, 2022; Casillas et al, 2019; Garcia et al, 2021; Jackson et al, 2017; Jang et al, 2022; Nakhla et al, 2021; Pluim et al, 2023; Spitzer & Weber, 2019; Tolea et al, 2020; Wu, 2016). This variability in findings may be related to the use of various assessment approaches, disparities in study recruitment or access to care, and group differences in characteristics other than culture that may also contribute to SCD such as education, socioeconomic status, and depression (Borelli et al, 2022; Jang et al, 2022; Lee et al, 2021; Rodriguez et al, 2021; Spitzer & Weber, 2019).…”