Cerebral Structure and Cognitive Performance in African Americans and European Americans with Type 2 Diabetes

Fang Chi Hsu, Kaycee M. Sink, Christina E. Hugenschmidt, Jeff D. Williamson, Timothy M. Hughes, Nicholette D. Palmer, Jianzhao Xu, S. Carrie Smith, Benjamin C. Wagner, Christopher T. Whitlow, Donald W. Bowden, Joseph A. Maldjian, Jasmin Divers, Barry I. Freedman

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)407-414
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume73
Issue number3
DOIs
StatePublished - Mar 2 2018

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African Americans
Type 2 Diabetes Mellitus
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Verbal Learning
Cardiovascular Diseases
Smoking
Stroop Test
Hypertension
Sex Education
Magnetic Resonance Imaging
Depression
Brain
White Matter

Keywords

  • Brain
  • Cognition
  • Educational quality
  • Health disparities
  • Minority aging

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

Cite this

Cerebral Structure and Cognitive Performance in African Americans and European Americans with Type 2 Diabetes. / Hsu, Fang Chi; Sink, Kaycee M.; Hugenschmidt, Christina E.; Williamson, Jeff D.; Hughes, Timothy M.; Palmer, Nicholette D.; Xu, Jianzhao; Smith, S. Carrie; Wagner, Benjamin C.; Whitlow, Christopher T.; Bowden, Donald W.; Maldjian, Joseph A.; Divers, Jasmin; Freedman, Barry I.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 73, No. 3, 02.03.2018, p. 407-414.

Research output: Contribution to journalArticle

Hsu, FC, Sink, KM, Hugenschmidt, CE, Williamson, JD, Hughes, TM, Palmer, ND, Xu, J, Smith, SC, Wagner, BC, Whitlow, CT, Bowden, DW, Maldjian, JA, Divers, J & Freedman, BI 2018, 'Cerebral Structure and Cognitive Performance in African Americans and European Americans with Type 2 Diabetes', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 73, no. 3, pp. 407-414. https://doi.org/10.1093/gerona/glx255
Hsu, Fang Chi ; Sink, Kaycee M. ; Hugenschmidt, Christina E. ; Williamson, Jeff D. ; Hughes, Timothy M. ; Palmer, Nicholette D. ; Xu, Jianzhao ; Smith, S. Carrie ; Wagner, Benjamin C. ; Whitlow, Christopher T. ; Bowden, Donald W. ; Maldjian, Joseph A. ; Divers, Jasmin ; Freedman, Barry I. / Cerebral Structure and Cognitive Performance in African Americans and European Americans with Type 2 Diabetes. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2018 ; Vol. 73, No. 3. pp. 407-414.
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abstract = "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.",
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AU - Sink, Kaycee M.

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AU - Hughes, Timothy M.

AU - Palmer, Nicholette D.

AU - Xu, Jianzhao

AU - Smith, S. Carrie

AU - Wagner, Benjamin C.

AU - Whitlow, Christopher T.

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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.

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KW - Cognition

KW - Educational quality

KW - Health disparities

KW - Minority aging

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