WHICAP
Washington
Heights/Hamilton HeightsInwood Columbia Aging
Project
Jennifer J. Manly, PhD
Columbia University Medical Center
jjm71@columbia.edu
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.
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)
INWOOD
PI: Richard Mayeux
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
50
Percent of cohort
•
•
•
•
•
•
40
30
20
10
0
Caucasian
African
American
Hispanic
Annual age-specific incidence
Age-Specific Incidence of
Alzheimer’s Disease
Tang et al., 2001; Neurology 56: 49-56
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.
RACE
“ An inbreeding, geographically isolated
population that differs in distinguishable
physical traits from other members of the
same species.”
Zuckerman, 1990; p. 1297
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
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
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
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
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?
No significant ethnic differences
in frequency of MCI
14
12
Percent
10
White
8
Black
6
Hispanic
4
2
0
MCI with memory
impairment
MCI with no memory
impairment
Manly et al, Arch Neurol (2005)
Length of School Term
Proportion of variance in cognitive test scores
explained by state of elementary education
Manly, Glymour, and Weiss (in preparation)
English Reading Level
Wide Range Achievement Test - reading subtest
I V Z J Q
see red milk was
between
cliff stalk grunt
clarify residence urge rancid
conspiracy deny quarantine deteriorate
regime
beatify
internecine regicidal
puerile
factitious lucubration
epithalamion
inefficacious
synecdoche
READING LEVEL AND
YEARS OF EDUCATION
WRAT-3
estimate
0-3
4-6
7-8
9-12
13+
Self-reported
years of education
0-3
3
2
4-6
8
5
2
2
1
7-8
5
6
2
9
3
9-12
11
11
16
30
40
13+
1
3
40
40
ETHNICITY, GRADE, AND
READING LEVEL
A fric a n -
n o n -H is p a n ic
A m e ric a n
W h ite
N
125
74
re a d in g le v e l = a c tu a l g ra d e
29%
47%
re a d in g le v e l > a c tu a l g ra d e
24%
35%
re a d in g le v e l < a c tu a l g ra d e
47%
18%
Reading ability accounts for
ethnic group differences
African
White
ANCOVA
American
with
ANOVA
N = 192 N = 192
WRAT-3
Test
Mean
Memory
SRT Total recall
SRT Delayed recall
Benton figure recognition
Orientation
10 Items from MMSE
Abstract Reasoning
WAIS-R Similarities
Identities/oddities total
Mean
F
F
39.8
5.8
7.4
43.5
6.7
8.1
12.9**
8.9*
20.4**
1.7
0.7
2.5
9.7
9.8
3.5
12.0
14.6
16.0
15.1
34.8**
10.8*
3.7
1.8
** p < .01; *** p < .001
Manly et al, 2002, J Int Neuropsychol Soc 8: 341-348
Reading ability accounts for
ethnic group differences
Test
African
White
ANCOVA
American
with
ANOVA
N = 192 N = 192
WRAT-3
Mean
Language
15-item Boston Naming
Letter fluency
Category fluency
BDAE Repetition
BDAE Comprehension
Visuospatial skill
Rosen Drawing
Benton Figure Matching
Mean
F
14.0
9.9
14.6
7.8
5.5
14.1
12.2
16.8
7.8
5.8
0.5
31.8**
31.4**
0.0
13.4**
2.6
8.9
3.0
9.4
30.0**
13.1**
F
10.0*
0.8
3.2
10.9*
3.4
* p < .05; ** p < .01
Manly et al, 2002, J Int Neuropsychol Soc 8: 341-348
Determinants of cross-sectional language test
performance
***
***
***
***
***
All models are adjusted for age and sex
***
***
***
Literacy and Memory
Manly et al., JCEN 2003
Race, education, literacy, & incident AD
***
Relative Risk
***
***
***
** p < .01; *** p < .001
**
Memory
Language
Visual-spatial
Speed
SRT-Total
e1
SRT- Delayed recall
e2
SRT- Delayed recog
e3
Naming total
e4
Letter Fluency
e5
Category Fluency
e6
Similarities
e7
Repetition
e8
Comprehension
e9
BVRT recognition
e10
BVRT Matching
e11
Rosen
e12
Identities/Oddities
e13
Color Trails 1
e14
Color Trails 2
e15
Spanish Reading Level
Word Accentuation Test
ACULLA
ABOGACIA
ANOMALO
CELIBE
ALELI
RABI
APATRIDA
HUSAR
ALEGORIA
MANCHU
DIAMETRO
MOARE
CONCAVO
AMBAR
PUGIL
POLIGAMO
ACME
SILICE
GRISU
ALBEDRIO
CANON
PIFANO
TACTIL
VOLATIL
DESCORTES
DISCOLO
BULGARO
BALADI
ACOLITO
CUPULA
Del Ser et al., 1997
Predicting Incident AD among Hispanic Immigrants
n = 670
Model 1
Model 1
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
-.238
.242
-.110
.608
-.038
.865
.046
.840
-1.225
.060
-1.055
.113
-.669
.350
-.082
.000
-.081
.000
.381
.140
Variables in the
Model
Dominican vs.
other
Time in the US
Spanish Reading
English Fluency
Model 2
Model 3
Model 4
Sensitivity and specificity of selfreported 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
Age, ethnicity, and relative WMH volume
Brickman et al., in press