Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors

Article type: Research Article

Authors: Lamar, Melissa^{a; b; *} | Drabick, Deborah^c | Boots, Elizabeth A.^{a; d} | Agarwal, Puja^{a; e} | Emrani, Sheina^f | Delano-Wood, Lisa^{g; h} | Bondi, Mark W.^{g; h} | Barnes, Lisa L.^{a; b; i} | Libon, David J.^j

Affiliations: [a] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [b] Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA | [c] Department of Psychology, Temple University, Philadelphia, PA, USA | [d] Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA | [e] Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA | [f] Department of Psychology, Rowan University, Glassboro, NJ, USA | [g] Veterans Affairs San Diego Healthcare System, San Diego, CA, USA | [h] Department of Psychiatry, University of California, San Diego, San Diego, CA, USA | [i] Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA | [j] Rowan University School of Osteopathic Medicine, New Jersey Institute for Successful Aging Departments of Geriatrics and Gerontology and Psychology, Stratford, NJ, USA

Correspondence: [*] Correspondence to: Melissa Lamar, PhD, Rush Alzheimer’s Disease Center, Rush University Medical Center, 1750 W Harrison Street, Suite 1000, Chicago, IL 60612, USA. Tel.: +1 312 942 3365; E-mail: Melissa_Lamar@rush.edu.; Twitter:@DrMLamar

Abstract: Background:Cognitively-defined subgroups are well-documented within neurodegeneration. Objective:We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration. Methods:121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, ‘animal’ fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders. Results:Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001). Conclusion:LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.

Keywords: Aging, cognition, diversity, latent profile analysis, lifestyle, Mediterranean diet

DOI: 10.3233/JAD-210110

Journal: Journal of Alzheimer's Disease, vol. 82, no. 4, pp. 1833-1846, 2021