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WHICAP Washington Heights/Hamilton Heights- Inwood Columbia Aging Project

WHICAP Washington Heights/Hamilton Heights- Inwood Columbia Aging Project. Jennifer J. Manly, PhD Columbia University Medical Center jjm71@columbia.edu. Acknowledgements. Funded in part by Grant R13AG030995-01A1 from the National Institute on Aging

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WHICAP Washington Heights/Hamilton Heights- Inwood Columbia Aging Project

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  1. WHICAPWashington Heights/Hamilton Heights-Inwood Columbia Aging Project Jennifer J. Manly, PhD Columbia University Medical Center jjm71@columbia.edu

  2. Acknowledgements • Funded in part by Grant R13AG030995-01A1 from the National Institute on Aging • The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

  3. Collaborators Lenny Cedano Raquel Cabo Yaakov Stern Richard Mayeux Nicole Schupf Maria Glymour Christopher Weiss Adam Brickman Karen Siedlecki Robert Heaton Supported by • NIA R01 AG16206 (PI: Manly) • NIA P01 AG07232 (PI: Mayeux)

  4. PI: Richard Mayeux INWOOD WASHINGTON HEIGHTS HAMILTON HEIGHTS • N = 2125 in 1992 • Added 2174 in1999 to total 2801 • Age 65 and older • Spanish or English speaking • Seen in home at 18 – 24 month intervals • Dx based on neuropsychological test battery, medical & functional interview

  5. Age-Specific Incidence of Alzheimer’s Disease Annual age-specific incidence Tang et al., 2001; Neurology 56: 49-56

  6. Underlying all comparisons of test performance between racial/ethnic groups is the fallacy imbedded in racial/ethnic classifications: that there is a biological or genetic basis for race.

  7. RACE “ An inbreeding, geographically isolated population that differs in distinguishable physical traits from other members of the same species.” Zuckerman, 1990; p. 1297

  8. Hypertension & SES • Research shows that the higher rates of hypertension among African Americans as compared to Whites “persists” after adjusting for traditional indicators of SES (e.g., years of education, income) • Genes for hypertension unique to African Americans are being sought

  9. Hypertension & SES • Accounting for assets, debt, use of public assistance, and neighborhood-level indicators of income explains racial differences in hypertension Cooper & Kaufman, 1998; Kaufman et al., 1997 • Perceived discrimination and residential segregation perception of discrimination have significant associations with hypertension Krieger, 1999; Williams, 1997; Williams & Neighbors, 2001; Williams, Neighbors, & Jackson, 2003; Williams, Massing, Rosamond, Sorlie, & Tyroler, 1999; Wyatt et al., 2003

  10. Race • Used as a proxy for assumed educational, socioeconomic, biological, or behavioral differences • Diversity within ethnic groups: • Educational • Linguistic • Geographic • Economic • Exposure to Mainstream culture • Racial classification is fluid over time and place

  11. DECONSTRUCTING RACE AND EDUCATION • Assume these variables are proxies for more meaningful underlying factors • Determine which aspects of the variable are expected to affect test performance • Premorbid • Change over time • Determine relationship to test performance • Adjust for significant factors before interpreting scores, regardless of race

  12. MCI in an ethnically and educationally diverse cohort • Most MCI studies are clinic-based Caucasian, well educated participants • How can MCI criteria be operation among ethnically, linguistically, and educationally diverse elders? • What implications do the use of robust norms in this diverse sample have on MCI prevalence and outcomes?

  13. No significant ethnic differences in frequency of MCI Percent Manly et al, Arch Neurol (2005)

  14. Length of School Term

  15. Proportion of variance in cognitive test scores explained by state of elementary education Manly, Glymour, and Weiss (in preparation)

  16. English Reading Level Wide Range Achievement Test - reading subtest I V Z J Q see red milk was between cliff stalk grunt clarify residence urge rancid conspiracy deny quarantine deteriorate regime beatify internecine regicidal puerile factitious lucubration epithalamion inefficacious synecdoche

  17. READING LEVEL AND YEARS OF EDUCATION

  18. ETHNICITY, GRADE, AND READING LEVEL

  19. Reading ability accounts for ethnic group differences ** p < .01; *** p < .001 Manly et al, 2002, J Int Neuropsychol Soc 8: 341-348

  20. Reading ability accounts for ethnic group differences * p < .05; ** p < .01 Manly et al, 2002, J Int Neuropsychol Soc 8: 341-348

  21. Determinants of cross-sectional language test performance *** *** *** *** *** *** *** *** All models are adjusted for age and sex

  22. Literacy and Memory Manly et al., JCEN 2003

  23. Race, education, literacy, & incident AD *** *** *** Relative Risk ** *** ** p < .01; *** p < .001

  24. Spanish Reading LevelWord Accentuation Test ACULLA ABOGACIA ANOMALO CELIBE ALELI RABI APATRIDA HUSAR ALEGORIA MANCHU DIAMETRO MOARE CONCAVO AMBAR PUGIL POLIGAMO ACME SILICE GRISU ALBEDRIO CANON PIFANO TACTIL VOLATIL DESCORTES DISCOLO BULGARO BALADI ACOLITO CUPULA Del Ser et al., 1997

  25. Predicting Incident AD among Hispanic Immigrantsn = 670

  26. Sensitivity and specificity of self-reported stroke 717 nondemented elders scanned 225 persons had a brain infarct on MRI Reitz et al., submitted

  27. Age, ethnicity, and relative WMH volume Brickman et al., in press

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