Predictors of Cognitive Decline in a Multi-Racial Sample of Midlife Women

Jasmine S. Dixon, Alice E. Coyne, Kevin Duff, and Rebecca E. Ready

African Americans are at increased risk for dementia compared to European Americans (Mayeda, et al., 2016; Mehta & Yeo, 2017; Steenland et al., 2015) and there are nearly twice as many women diagnosed with Alzheimer’s disease (AD) than men (Hebert et al., 2013). Indeed, race and gender interact to determine risk for cognitive decline with age. African American women experienced steeper cognitive decline compared to their European Americans counterpart (Avila et al., 2019). Greater attention on the cognitive disparities and cognitive aging of women from racially diverse backgrounds is warranted to better understand how to prevent cognitive decline. Midlife is an ideal time to study cognitive aging since the neuropathology for dementia may begin at this stage in life (Sperling et al., 2011).

In later life, we know that depressive symptoms, diabetes, hypertension, and smoking are risk factors for cognitive decline and/or impairment in older adults (see Supplemental Materials 1; e.g., Anstey et al., 2007; Brewster et al., 2017; Hajjar et al., 2017; Wennberg et al., 2017).

However, it is unknown if these risk factors are important in predicting cognitive decline during midlife (see Supplemental Materials 2; e.g., Anstey et al., 2014; Debette et al., 2011; Knopman et al., 2001; Singh-Manoux & Marmot, 2005; Tarraf et al., 2017). Even less is known about predictors for cognitive decline during midlife in multi-racial samples (Anstey et al., 2014; Lachman, 2016; Lachman et al., 2015).

The present study—using longitudinal data from the Study of Women’s Health Across the Nation (SWAN; Sowers et al., 2000)—will fill important gaps in knowledge by determining if diabetes, hypertension, smoking, and/or depressive symptoms are associated with cognitive decline in midlife women.

We expect these risk factors will be associated with cognitive changes at midlife. Further, based on a health disparity framework, we predict stronger associations between risk factors and cognitive decline for African American women compared to European American women.

We will explore risk for cognitive decline in Asian American women relative to our other racial groups.

This study will focus on cognitive outcomes that are likely to change with age, namely episodic memory, working memory, and processing speed (Kandiah et al., 2009; Kirova et al., 2015; McGuinness et al., 2010; O’Brien & Thomas, 2015; Stopford et al., 2010).

By gaining a better understanding of predictors of poor cognition during midlife in a multiracial sample of women, prevention and treatment efforts can be better directed to persons most at risk for cognitive decline.