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Background: Variability in dementia rates across racial and ethnic groups has been estimated at 60%. Studies suggest disparities in Caribbean Hispanic and Black populations, but community-based data are limited.Objective: Estimate the prevalence of mild cognitive impairment (MCI) and dementia in the racially and ethnically diverse community-based Northern Manhattan Study cohort and examine sociodemographic, vascular risk factor, and brain imaging correlates.Methods: Cases of MCI and dementia were adjudicated by a team of neuropsychologists and neurologists and prevalence was estimated across race/ethnic groups. Ordinal proportional odds models were used to estimate race/ethnic differences in the prevalence of MCI or dementia adjusting for sociodemographic variables (model 1), model 1 plus potentially modifiable vascular risk factors (model 2), and model 1 plus structural imaging markers of brain integrity (model 3).Results: There were 989 participants with cognitive outcome determinations (mean age 69±9 years; 68% Hispanic, 16% Black, 14% White; 62% women; mean (±SD) follow-up five (±0.6) years). Hispanic and Black participants had greater likelihood of MCI (20%) and dementia (5%) than White participants accounting for age and education differences. Hispanic participants had greater odds of MCI or dementia than both White and Black participants adjusting for sociodemographic variables, vascular risk factors, and brain imaging factors. White matter hyperintensity burden was significantly associated with greater odds of MCI or dementia (OR = 1.3, 1.1 to 1.6), but there was no significant interaction by race/ethnicity.Conclusion: In this diverse community-based cohort, cross-sectional data revealed significant race/ethnic disparities in the prevalence of MCI and dementia. Longer follow-up and incidence data are needed to further clarify these relationships. [ABSTRACT FROM AUTHOR]

Objectives The main objective of this study was to estimate effects of dementia on Medicaid expenditures in an ethnically diverse community. Methods The sample included 1,211 Medicare beneficiaries who did not have any Medicaid coverage and 568 who additionally had full Medicaid coverage enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in northern Manhattan (1999–2010). Individuals' dementia status was determined using a rigorous clinical protocol. Relationship between dementia and Medicaid coverage and expenditures were estimated using a two-part model. Results In participants who had full Medicaid coverage, average annual Medicaid expenditures were substantially higher for those with dementia than those without dementia ($50,270 vs. $21,966, p <.001), but Medicare expenditures did not differ by dementia status ($8,458 vs. $9,324, p =.19). In participants who did not have any Medicaid coverage, average annual Medicare expenditures were substantially higher for those with dementia than those without dementia ($12,408 vs. $8,113, p =.02). In adjusted models, dementia was associated with a $6,278 increase in annual Medicaid spending per person after controlling for other characteristics. Discussion Results highlight Medicaid's contribution to covering the cost of dementia care in addition to Medicare. Studies that do not include Medicaid are unlikely to accurately reflect the true cost of dementia. [ABSTRACT FROM AUTHOR]

Objectives To determine whether observed hearing loss (OHL) is associated with incident dementia in a multiethnic population. Design Prospective epidemiological cohort study. Setting Community in northern Manhattan. Participants Participants in the Washington Heights-Inwood Columbia Aging Project, a longitudinal study on aging and dementia in an ethnically diverse community (n = 1,881). Measurements OHL was defined when the examiner observed it or according to self-reported hearing aid use. A consensus panel diagnosed dementia using standard research criteria. A Cox proportional hazards model was used to examine the relationship between OHL at baseline and risk of incident dementia (mean 7.3 ± 4.4 years of longitudinal followup, range 0.9-20 years). Results OHL was associated with 1.69 (95% confidence interval (CI) = 1.3-2.3, P < .010) times the risk of incident dementia, adjusting for demographic characteristics, cardiovascular risk factors, apolipoprotein E4 genotype, and stroke. When stratified according to race, the association between OHL and incident dementia was high in all groups but was statistically significant only in blacks (hazard ratio = 2.62, 95% CI = 1.5-4.5, P < .010). Conclusion OHL was associated with greater risk of incident dementia in a multiethnic cohort. More study is needed to determine whether HL contributes to dementia and whether treating HL can reduce the risk of dementia. [ABSTRACT FROM AUTHOR]

Objectives To determine whether infectious burden ( IB) is associated with worse performance and decline on a battery of neuropsychological tests. Design Prospective cohort study (Northern Manhattan Study ( NOMAS)). Setting Community. Participants A subsample of 588 stroke-free NOMAS participants with IB and cognitive data (mean age 71 ± 8, 62% female, 14% white, 16% black, 70% Hispanic) and 419 with repeat cognitive testing. Measurements Samples used for IB data were collected at baseline. Two waves of neurocognitive assessments occurred during follow-up. Participants underwent a neuropsychological battery and had repeated testing (mean time span 6 ± 2 years). Using factor analysis-derived domain-specific Z scores for language, memory, executive function, and processing speed, associations between a quantitative stroke risk-weighted IB index ( IBI), based on five common infections ( Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, herpes simplex viruses 1 and 2), and cognitive performance and decline in each domain was examined. Results Adjusting for demographic characteristics, socioeconomic status, crystallized cognitive abilities, and vascular risk factors, the IBI was inversely associated with executive function at baseline (beta = −0.10, P = .01) but not with baseline language, memory, or processing speed performance in adjusted analyses. The IBI was associated with cognitive decline in the memory domain, adjusting for demographic and vascular risk factors ( P = .02). Conclusion A quantitative stroke risk-weighted measure of IB explained variability in baseline executive function performance and associated with decline in memory. Past exposure to common infections may contribute to vascular cognitive impairment and warrants further study. [ABSTRACT FROM AUTHOR]

Objectives To determine whether depressive symptoms typically precede or follow memory declines. Design An autoregressive latent trajectory model was used to examine the direction of the relationship between depressive symptoms and memory decline observed over 12 years. Setting Washington/ Hamilton Heights Inwood Columbia Aging Project, a community-based longitudinal study of aging and dementia in northern Manhattan. Participants Older adults initially without dementia (n = 2,425). Measurements Memory composite scores were computed from three subscores of the Selective Reminding Test. Depressive symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression Scale. Analyses controlled for age, sex, recruitment wave, education, black race, and Hispanic ethnicity measured at baseline and chronic disease burden measured at each study visit. Results Initial depressive symptoms predicted worse memory scores at the second study visit ( B weight = −0.03; P = .003) and accelerated memory decline over the entire study period ( B weight = −0.02; P = .03). Memory scores did not predict subsequent depressive symptoms. Conclusion These findings suggest that depressive symptoms precede memory decline, but not vice versa, in late life. This pattern of results is consistent with hypotheses that depression is a prodrome of dementia or a causal contributor to memory decline. Clinicians should be aware that depressive symptoms may represent an early indicator not only of dementia, as reported previously, but also of memory decline more generally. [ABSTRACT FROM AUTHOR]

Objective: To measure brain volume deficits among underweight patients with anorexia nervosa (AN) compared to control participants and evaluate the reversibility of these deficits with shortterm weight restoration. Method: Brain volume changes in gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were examined in 32 adult women with AN and compared to 21, age and body mass index-range matched control women. Results: Patients with AN had a significant increase in GM (p 5 .006, g2 5 0.14) and WM volume (p 5 .001, g2 5 0.19) following weight restoration. Patients on average had lower levels of GM at low weight (647.63 6 62.07 ml) compared to controls (679.93 6 53.31 ml), which increased with weight restoration (662.64 6 69.71 ml), but did not fully normalize. Discussion: This study suggests that underweight adult patients with AN have reduced GM and WM volumes that increase with short-term weight restoration. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the combined association of diet and physical activity with Alzheimer's disease risk. The study involved 1,880 community-dwelling elders without dementia in New York City with both diet and physical activity information available. The participants undertook standardized neurological and neuropsychological measures from 1992 through 2006. An association between both higher Mediterranean-type diet and higher physical activity with reduced risk for Alzheimer's disease were found by the researchers.

Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid Home Care Services Program were merged with epidemiologic and diagnostic data collected in a community study of older adults living in northern Manhattan. Of 866 older adults with Medicaid coverage living in the community, 288 (33.3%) received Medicaid home care services in the period from 1994 to 1996. Mortality was tracked through the end of 1999. Results: In proportional hazards models that adjusted for differences in sociodemographic, medical, and functional status, use of Medicaid home care service was associated with a significantly reduced risk death in people with disability in activities of daily living. Implications: Because the program has distinctive features (greater number of weekly hours than other programs, integration with nursing assessments), it is a special case of community-based long-term care. Still, results from this observational cohort suggest that mortality risk in the most vulnerable elderly population can be reduced through a program of supportive care. [ABSTRACT FROM AUTHOR]

Investigates the association of mobility deficit in the absence of deficits in activities of daily living (ADL) with mortality in New York City. Effects of chronic progressive diseases on mobility; Reduction in walking speed with aging; Increase in mortality rate with ADL disability.

Cognitive reserve is a hypothetical construct that has been used to inform models of cognitive aging and is presumed to be indicative of life experiences that may mitigate the effects of brain pathology. The purpose of this study was to evaluate the construct validity of cognitive reserve by examining both its convergent and its discriminant validity across three different samples of participants using structural equation modeling. The cognitive reserve variables were found to correlate highly with one another (thereby providing evidence of convergent validity), but demanding tests of discriminant validity indicated that, in two of the samples, the cognitive reserve construct was highly related to an executive functioning construct. [ABSTRACT FROM AUTHOR]