TY - JOUR
T1 - Cerebral Structure and Cognitive Performance in African Americans and European Americans with Type 2 Diabetes
AU - Hsu, Fang Chi
AU - Sink, Kaycee M.
AU - Hugenschmidt, Christina E.
AU - Williamson, Jeff D.
AU - Hughes, Timothy M.
AU - Palmer, Nicholette D.
AU - Xu, Jianzhao
AU - Smith, S. Carrie
AU - Wagner, Benjamin C.
AU - Whitlow, Christopher T.
AU - Bowden, Donald W.
AU - Maldjian, Joseph A.
AU - Divers, Jasmin
AU - Freedman, Barry I.
N1 - Funding Information:
This work was supported by National Institutes of Health General Clinical Research Center of Wake Forest School of Medicine M01 RR07122; National Institute of Neurological Disorders and Stroke R01 NS075107 (to B.I.F.) and NS058700 (to D.W.B.); and National Institute of Diabetes and Digestive and Kidney Diseases R01 DK071891 (to B.I.F.).
Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
PY - 2018/3/2
Y1 - 2018/3/2
N2 - Background African Americans typically perform worse than European Americans on cognitive testing. Contributions of cardiovascular disease (CVD) risk factors and educational quality to cognitive performance and brain volumes were compared in European Americans and African Americans with type 2 diabetes. Methods Association between magnetic resonance imaging-determined cerebral volumes of white matter (WMV), gray matter (GMV), white matter lesions (WMLV), hippocampal GMV, and modified mini-mental state exam (3MSE), digit symbol coding (DSC), Rey Auditory Verbal Learning Test (RAVLT), Stroop, and verbal fluency performance were assessed in Diabetes Heart Study Memory in Diabetes (MIND) participants. Marginal models incorporating generalized estimating equations were employed with serial adjustment for risk factors. Results The sample included 520 African Americans and 684 European Americans; 56 per cent female with mean ± SD age 62.8 ± 10.3 years and diabetes duration 14.3 ± 7.8 years. Adjusting for age, sex, diabetes duration, BMI, HbA1c, total intracranial volume, scanner, statins, CVD, smoking, and hypertension, WMV (p =.001) was lower and WMLV higher in African Americans than European Americans (p =.001), with similar GMV (p =.30). Adjusting for age, sex, education, HbA1c, diabetes duration, hypertension, BMI, statins, CVD, smoking, and depression, poorer performance on 3MSE, RAVLT, and DSC were seen in African Americans (p = 6 × 10 -23 -7 × 10 -62). Racial differences in cognitive performance were attenuated after additional adjustment for WMLV and nearly fully resolved after adjustment for wide-range achievement test (WRAT) performance (p =.0009-.65). Conclusions African Americans with type 2 diabetes had higher WMLV and poorer cognitive performance than European Americans. Differences in cognitive performance were attenuated after considering WMLV and apparent poorer educational quality based on WRAT.
AB - Background African Americans typically perform worse than European Americans on cognitive testing. Contributions of cardiovascular disease (CVD) risk factors and educational quality to cognitive performance and brain volumes were compared in European Americans and African Americans with type 2 diabetes. Methods Association between magnetic resonance imaging-determined cerebral volumes of white matter (WMV), gray matter (GMV), white matter lesions (WMLV), hippocampal GMV, and modified mini-mental state exam (3MSE), digit symbol coding (DSC), Rey Auditory Verbal Learning Test (RAVLT), Stroop, and verbal fluency performance were assessed in Diabetes Heart Study Memory in Diabetes (MIND) participants. Marginal models incorporating generalized estimating equations were employed with serial adjustment for risk factors. Results The sample included 520 African Americans and 684 European Americans; 56 per cent female with mean ± SD age 62.8 ± 10.3 years and diabetes duration 14.3 ± 7.8 years. Adjusting for age, sex, diabetes duration, BMI, HbA1c, total intracranial volume, scanner, statins, CVD, smoking, and hypertension, WMV (p =.001) was lower and WMLV higher in African Americans than European Americans (p =.001), with similar GMV (p =.30). Adjusting for age, sex, education, HbA1c, diabetes duration, hypertension, BMI, statins, CVD, smoking, and depression, poorer performance on 3MSE, RAVLT, and DSC were seen in African Americans (p = 6 × 10 -23 -7 × 10 -62). Racial differences in cognitive performance were attenuated after additional adjustment for WMLV and nearly fully resolved after adjustment for wide-range achievement test (WRAT) performance (p =.0009-.65). Conclusions African Americans with type 2 diabetes had higher WMLV and poorer cognitive performance than European Americans. Differences in cognitive performance were attenuated after considering WMLV and apparent poorer educational quality based on WRAT.
KW - Brain
KW - Cognition
KW - Educational quality
KW - Health disparities
KW - Minority aging
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U2 - 10.1093/gerona/glx255
DO - 10.1093/gerona/glx255
M3 - Article
C2 - 29309525
AN - SCOPUS:85042931184
SN - 1079-5006
VL - 73
SP - 407
EP - 414
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 3
ER -