Weathering the Storm of Cognitive Inequities: Testing the Minority Stress and Cognition Model with Indigenous Older Adults

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Project Summary/Abstract The number of Indigenous older adults (IOAs) in the United States, defined here as Native American and Alaska Natives, will more than double in the next 30 years. Concurrently, the number of IOAs living with Alzheimer’s Disease and Related Dementias (ADRDs) will also increase. Our limited knowledge about the cognitive health of IOAs represents a crisis of health equity. This proposed study aims to not only shed new light on this issue, but also to promote the equitable inclusion of IOAs in cognitive health research, policy, and intervention. This proposed study is guided by a conceptual model that integrates these risk factors into a stress framework; the Minority Stress and Cognition Model. This model posits that exposure to higher levels of psychosocial stress in the form of individual (e.g. perceived racism) and systematic discrimination (e.g. low quality of education, poverty) increase one’s susceptibility to chronic health conditions and the risk of cognitive impairment in later life via an accumulation of allostatic load. This study extends this model to IOAs, a population of color that also experienced systemic racism, poor educational quality, poverty, health inequities, and racism in the United States. This proposal aims to address these knowledge gaps by using restricted Health and Retirement Study (HRS) data to investigate how an understudied group of IOAs fared over a 10-year period (2008-2018) in the domain of cognitive health. The specific aims of this proposed study are: 1) To investigate longitudinal differences in cognitive health between Indigenous, Black, Hispanic, and White older adults; 2) To determine how psychosocial factors are associated with total cognition trajectories among Indigenous, Black, Hispanic, and White older adults; and 3) To determine how behavioral, and physical stress factors are associated with total cognition trajectories among Indigenous, Black, Hispanic, and White older adults. I hypothesize that alongside other risk factors for cognitive impairment (e.g. low levels of education, low SES, alcohol and cigarette use, physical inactivity, high allostatic loads) higher levels of perceived discrimination will be associated with lower overall total cognition trajectories and earlier onset of decline. Using restricted data from the Health and Retirement Study Core sample and the 2008-2016 Leave-Behind Questionnaire, this proposed study will investigate the change on a measure of total cognitive function (TICS-M). To do this, total cognitive function trajectories will be fitted with sociodemographic information (age, gender, race/ethnicity) and then modified first by psychosocial and then by physical, and behavioral factors. These relationships will be assessed using several statistical methods: 1) descriptive statistics, 2) t-test and chi-squared statistics, 3) correlation coefficients, and 4) mixed effect growth curve models. Missing data treatment will be conducted using Full Information Maximum Likelihood estimation. This proposed study has important implications for stress and cognition models, the health equity of Indigenous older adults, and future preventative research. This proposal is responsive to PAR-19-394: Aging Research Dissertation Awards to Increase Diversity.