Associations of Nativity and the Role of the Hispanic Paradox on the Cognitive Health of Older Latinos Living in the United States

Article type: Research Article

Authors: Jaen, Jocelyn^a | Grodstein, Francine^{b; c} | Lajous, Martín^{a; d} | Bello-Chavolla, Omar Yaxmehen^e | Gómez-Flores-Ramos, Liliana^f | Yang, Jingyun^{b; g} | Bennett, David A.^{b; g} | Marquez, David X.^{b; h} | Lamar, Melissa^{b; i; *}

Affiliations: [a] Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico | [b] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [c] Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA | [d] Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA | [e] Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico | [f] CONAHCYT/Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico | [g] Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA | [h] Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA | [i] Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA

Correspondence: [*] Correspondence to: Melissa Lamar, PhD, Professor, 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:US-based Latinos have lower education and income combined with higher health risks than non-Latino whites, but often ‘paradoxically’ evidence better health-related outcomes. Less work has investigated this paradox for cognitive-related outcomes despite nativity diversity. Objective:We evaluated cognitive aging within older Latinos of diverse nativity currently living in the US and participating in Rush Alzheimer’s Disease Center studies. Methods:Participants without baseline dementia, who completed annual neuropsychological assessments (in English or Spanish) were grouped by US-born (n = 117), Mexico-born (n = 173), and born in other Latin American regions (LAr-born = 128). Separate regression models examined associations between nativity and levels of (N = 418) or change in (n = 371; maximum follow-up ∼16 years) global and domain-specific cognition. Results:Demographically-adjusted linear regression models indicated that foreign-born nativity was associated with lower levels of global cognition and select cognitive domains compared to US-born Latinos. No associations of nativity with cognitive decline emerged from demographically-adjusted mixed-effects models; however, Mexico-born nativity appeared associated with slower declines in working memory compared to other nativity groups (p-values ≥ 0.051). Mexico-born Latinos had relatively higher vascular burden and lower education levels than other nativity groups; however, this did not alter results. Conclusions: Nativity differences in baseline cognition may be due, in part, to accumulated stressors related to immigration and acculturation experienced by foreign-born Latinos which may hasten meeting criteria for dementia later in life. In contrast, Mexico-born participants’ slower working memory declines, taken in the context of other participant characteristics including vascular burden, suggests the Hispanic Paradox may relate to factors with the potential to affect cognition

Keywords: Alzheimer’s disease, Hispanic Paradox, Latinos, nativity, working memory

DOI: 10.3233/JAD-231358

Journal: Journal of Alzheimer's Disease, vol. 99, no. 3, pp. 981-991, 2024