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Comparative Study
. 2018 Feb;24(2):176-187.
doi: 10.1017/S1355617717000820. Epub 2017 Sep 18.

Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia

Shanna L Burke  1 , Miriam J Rodriguez  2 , Warren Barker  3 , Maria T Greig-Custo  3 , Monica Rosselli  4 , David A Loewenstein  5 , Ranjan Duara  3
Affiliations
Comparative Study

Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia

Shanna L Burke et al. J Int Neuropsychol Soc. 2018 Feb.

Abstract

Objectives: The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity.

Methods: Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group.

Results: Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects.

Conclusions: Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018, 24, 176-187).

Keywords: Atrophy; Biomarkers; Cognition; Dementia; Entorhinal cortex; Hippocampus; Hispanic Americans; Lateral ventricles; Mild cognitive impairment; Neurodegenerative diseases.

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Figures

Fig. 1.
Fig. 1.
a: Bar graph demonstrating the mean Mini-Mental State Examination (MMSE) scores for Hispanic and white non-Hispanic (WNH) subjects with a cognitive classification of cognitively normal (CN), amnestic mild cognitive impairment (aMCI), or dementia. There are significant differences between the cognitive groups (F[5,159] = 49.93; p < .000). b: Among the clinical diagnostic measures, significant differences across groups were found in the Fuld Object Memory Evaluation (FOME) [F(5,159) = 61.99; p < .000]. c: Among the clinical diagnostic measures significant differences across groups were found in the Clinical Dementia Rating (CDR) Sum of Boxes (SOB) [F(5,159) = 64.79; p < .000].
Fig. 2.
Fig. 2.
a: Means for regional visual rating scale (VRS) scores showed a progressive decline in bilateral hippocampal volume (HPCv) cognitively normal (CN) to dementia, with HPCv left (L) [F(159) = 20.87; p < .000], HPCv right (R) [F(5,159) = 18.69; p < .000]. Smaller means for the hippocampus (HP) among WNHs compared with Hispanics indicate a higher level of atrophy among WNHs. b: Means for regional volumes and regional visual rating scale (VRS) scores showed a progressive decline in bilateral entorhinal cortex volume (ECv) from CN to dementia, with ECv L [F(5,159) = 20.04; p < .000] and ECv R [F(5,159) = 13.97; p < .000]. c: A main effect for ethnicity was noted for bilateral inferior lateral ventricle volume (ILVv): ILVv L [F(2,162) = 13.46; p < .000] and ILV R [F(2,162) = 10.51; p < .000]. A main effect for diagnosis was noted for bilateral ILVv: ILVv L [F(5,159) = 14.03; p < .000] and ILV R [F(5,159) = 13.80; p < .000]. An interaction effect for diagnosis and ethnicity approached significance for bilateral ILVv: ILVv [F(2,162) = 3.60; p < .049] and ILVv R [F(2,162) = 3.07; p < .03]. Overall, there were larger means for bilateral ILVv among WNH, compared with Hispanics. InfL V, ILV.
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