WHICAP Washington Heights/Hamilton Heights-Inwood Columbia Aging Project

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WHICAPWashington Heights/Hamilton Heights-Inwood
Columbia Aging Project

• Jennifer J. Manly, PhD
• Columbia University Medical Center
• jjm71_at_columbia.edu

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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.

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Collaborators

• Maria Glymour
• Christopher Weiss
• Adam Brickman
• Karen Siedlecki
• Robert Heaton

Lenny Cedano Raquel Cabo Yaakov Stern Richard
Mayeux Nicole Schupf
Supported by

• NIA R01 AG16206 (PI Manly)
• NIA P01 AG07232 (PI Mayeux)

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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

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Age-Specific Incidence of Alzheimers Disease
Annual age-specific incidence
Tang et al., 2001 Neurology 56 49-56
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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.
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RACE
An inbreeding, geographically isolated
population that differs in distinguishable
physical traits from other members of the same
species.
Zuckerman, 1990 p. 1297
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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

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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

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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

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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

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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?

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No significant ethnic differences in frequency
of MCI
Percent
Manly et al, Arch Neurol (2005)
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Length of School Term
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Proportion of variance in cognitive test scores
explained by state of elementary education
Manly, Glymour, and Weiss (in preparation)
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English Reading Level
Wide Range Achievement Test - reading subtest I
V Z J Q see red milk was between cliff stalk g
runt clarify residence urge rancid conspiracy deny
quarantine deteriorate regime beatify internecin
e regicidal puerile factitious lucubration epithal
amion inefficacious synecdoche
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READING LEVEL AND YEARS OF EDUCATION
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ETHNICITY, GRADE, AND READING LEVEL
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Reading ability accounts for ethnic group
differences
p lt .01 p lt .001
Manly et al, 2002, J Int Neuropsychol Soc 8
341-348
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Reading ability accounts for ethnic group
differences
p lt .05 p lt .01
Manly et al, 2002, J Int Neuropsychol Soc 8
341-348
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Determinants of cross-sectional language test
performance








All models are adjusted for age and sex
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Literacy and Memory
Manly et al., JCEN 2003
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Race, education, literacy, incident AD



Relative Risk


p lt .01 p lt .001
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Spanish Reading Level Word Accentuation Test
ACULLA ABOGACIA ANOMALO CELIBE ALELI RABI APATRIDA
HUSAR ALEGORIA MANCHU DIAMETRO
MOARE CONCAVO AMBAR PUGIL POLIGAMO ACME SILICE GRI
SU ALBEDRIO CANON PIFANO
TACTIL VOLATIL DESCORTES DISCOLO BULGARO BALADI AC
OLITO CUPULA
Del Ser et al., 1997
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Predicting Incident AD among Hispanic
Immigrantsn 670
Model 1 Model 1 Model 1 Model 1 Model 2 Model 2 Model 3 Model 3 Model 4 Model 4
Variables in the Model B p value B p value B p value B p value B p value
Age .103 .000 .106 .000 .103 .000 .107 .000 .106 .000
Sex .189 .352 .208 .307 .169 .410 .206 .330 .230 .280
Years of education -.073 .002 -.065 .009 -.051 .046 .033 .280 .038 .209
Dominican vs. other -.238 .242 -.110 .608 -.038 .865 .046 .840
Time in the US -1.225 .060 -1.055 .113 -.669 .350
Spanish Reading -.082 .000 -.081 .000
English Fluency .381 .140
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Sensitivity and specificity of self-reported
stroke
Sensitivity Specificity
All vascular territories 32.4 78.9
Large infarcts 51.5 78.1
Small infarcts 28.5 76.6
Cortical infarcts 40.0 76.3
Subcortical infarcts 33.1 77.3
717 nondemented elders scanned 225 persons had a
brain infarct on MRI
Reitz et al., submitted
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Age, ethnicity, and relative WMH volume
Brickman et al., in press
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