Experiences of structural, interpersonal and institutional racism are associated with lower memory scores and poorer cognition in midlife and old age, especially among black people, according to studies reported today at the Alzheimer’s Association International Conference® (AAIC®) 2022 in San Diego and virtually.
Key findings reported at AAIC 2022 include:
- In a study of nearly 1,000 middle-aged community-dwelling adults (55% Latinx; 23% Black; 19% White), exposure to interpersonal and institutional racism was associated with lower memory scores, and these associations were driven by Black individuals. Experiences of structural racism were associated with lower episodic memory across all racial and ethnic groups included in the study.
- In a study of 445 Asian, Black, Hispanic, White and multiracial people aged 90 and older, individuals who experienced widespread discrimination throughout their lives had lower semantic memory later in life than those who experienced little to no discrimination.
To achieve equity in health – as a step towards full inclusion – individuals and society must recognize and reduce racism and other forms of discrimination. We must create a society where the underserved, disproportionately affected and underrepresented are safe, cared for and valued.”
Carl V. Hill, Ph.D., MPH, Chief Diversity, Equity and Inclusion Officer at the Alzheimer’s Association
According to the Alzheimer’s Association Alzheimer’s Disease Facts and Figures 2022 Blacks are reported to be about twice as likely and Hispanic/Latino about one-and-a-half times as likely to have Alzheimer’s or other dementias.
The different types and experiences of structural racism and discrimination contribute to systemic inequalities, including: lower socioeconomic status; lower quality early childhood education; and less access to healthy food and adequate health care. These factors individually and cumulatively affect brain health throughout life in Black/African American, Hispanic/Latino, and other communities.
“These systemic inequalities are related to reduced access to key health-protective resources such as quality care and social networks that provide valuable health information and support,” said Rev. Miriam J. Burnett, MD, MDiv, MPH, medical director, African International Health Commission Methodist Episcopal Church.
“The ongoing and pervasive lack of resources, as well as social and environmental factors, are driving disparities in other health outcomes, such as cardiovascular disease and diabetes, that increase the risk of Alzheimer’s and other dementias,” said Adriana Perez, Ph.D. , CRNP, ANP-BC, FAAN, FGSA, Assistant Professor of Nursing at the University of Pennsylvania School of Nursing and a member of the National Association of Hispanic Nurses
Racism at multiple levels associated with lower memory scores
Research suggests that interpersonal and structural racism contribute to racial and ethnic differences in cognitive aging. However, there is little understanding of how racism affects cognition at multiple levels throughout the life course. To fill this knowledge gap, Dominika Šeblová, Ph.D., a postdoctoral fellow at the Gertrude H. Sergievsky Center at Columbia University Irving Medical Center, in collaboration with an interdisciplinary team of researchers with expertise in health justice, assessed experiences with interpersonal, institutional, and structural Racism among 942 middle-aged adults (mean age = 55; 64% female; 55% Latinx; 23% non-Latinx Black; 19% non-Latinx White).
Black participants were most exposed to racism at all levels. They were more likely to have grown up and lived in segregated areas known to be resource-poor due to institutional disinvestment in black neighborhoods. Black participants experienced an average of six civil rights violations in their lifetime and faced interpersonal discrimination at least once a week. These exposures were associated with lower memory scores, and the magnitude of the association corresponded to 1-3 years of chronological age. Structural racism was associated with lower episodic memory across the sample.
“Chronic exposure to racism and interpersonal discrimination in marginalized communities leads to stress that affects the body and affects physiological health, and likely contributes to the development of cognitive decline,” said Jennifer Manly, Ph.D., professor of Neuropsychology at Columbia University Irving Medical Center and the senior author of this work. “Taken together, our findings suggest that racism impairs brain health and contributes to the unfair burden of Alzheimer’s disease among marginalized groups.”
Poorer cognition among the elders is associated with experiences of discrimination
Discrimination is a fundamental cause of health inequalities. However, it is not known whether discrimination contributes to differences in cognitive aging among the oldest old, a group sometimes referred to as super-agers. To answer this question, Kristen George, Ph.D., an assistant professor of epidemiology in the Department of Public Health Sciences at the University of California, Davis, and colleagues examined the relationship between lifetime experiences of severe discrimination and cognitive functioning and decline in a variety of People Cohort of Asian, Black, White, Hispanic and mixed-race participants in the Life After 90 (LA90) study.
Among 468 participants (20.5% Asian; 21.8% Black; 14.5% Latino; 35.7% White; 7.5% mixed race), the median age at enrollment was 93. Participants completed three cognitive tests over one Average period of 1.2 years. The participants reported on experiences of serious lifelong discrimination via questionnaires and were grouped according to their answers.
- Group 1 reported discrimination in the workplace (i.e. wrongfully fired, not hired, not promoted) and consisted primarily of white males.
- Group 2 reported little to no discrimination throughout their lives and consisted of white women and older adults from Asia, blacks and Latinos.
- Group 3 reported experiencing discrimination in multiple areas (job, finance, housing, etc.) and all participants in this group were non-white.
Researchers found that participants in Group 1 (discrimination in the workplace) had higher levels of baseline cognition in areas of executive functioning and semantic memory compared to Group 2 (no discrimination). Group 3 (broad discrimination) had poorer semantic memory than group 2 at baseline. There were no differences in cognitive decline over time across groups.
“These results underscore that inequalities in cognitive function persist among the oldest old, after accounting for experiences of significant lifetime discrimination,” said George. “Despite this group’s incredible longevity, discrimination has an indelible impact on cognitive health, and the oldest old adults can still benefit from efforts to close and reconcile health disparities.”