+ PREDICTING FACTORS OF COGNITIVE DECLINE

AMONG THE ELDERLY: THE CASE OF MEXICANS IN

MEXICO AND THE UNITED STATES

SILVIA MEJIA-ARANGO

DEPARTAMENTO DE ESTUDIOS DE POBLACION

EL COLEGIO DE LA FRONTERA NORTE

TIJUANA, MEXICO

ROGELIO SAENZ

COLLEGE OF PUBLIC POLICY

UNIVERSITY OF TEXAS IN SAN ANTONIO

+IntroductionThe World report for AD and other dementias (2015): 46.8 millons of persons with dementia in the world. Projected to be 74.7 millions in 2030 and 131.5 millions in 2050 58% of the people with dementia live in low and middle income countries.

+In México (MHAS, 2011): 6% prevalence of global dementia 29% prevalence of cognitive impairment no dementia (CIND)Increases with age, decreases with years of education, and is higher in women 

Among the different ethnic groups in the US:Higher prevalence of dementia and cognitive impairment among blacks and Hispanics compared with non-Hispanic whites

+The differences among racial and

ethnic groups are a result of the interaction between genetic and environmental factors: Risk factors Health Behaviors Depression Networks Access to health services

+ObjectivesGeneral:The purpose of the present study was to examine cognitive decline ands its correlates among Mexicans and Mexican Americans Specific: To measure changes in cognitive function in the elderly over a 10-year period. To identify predictors of cognitive decline. To compare the effects of the predictor variables between Mexican-Americans and Mexicans

PREDICTOR VARIABLES1. SOCIODEMOGRAPHICS AND

EDUCATIONAL ATTAINMENTAge, sex, education,

2 MIGRATION Migrated, age of migration, years in the US3 FAMILY AND SOCIAL NETWORKS Married, see children, count on friends/relatives, have

someone to talk to4 PSYCHOLOGICAL FACTORS Depressive symptoms, locus of control for health,

importance of religion, volunteer or participate in non religious activities

5 OCCUPATION Employed at T1, Ever Employed, Principal Occupations,, money for medical care

6 ACCESS TO HEALTH Health insurance, Money problems for medical care

7 HEALTH BEHAVIORS Smoking, drinking 8 FUNCTIONALITY Need help in 1> ADLs or 2> IADLs9 SENSORY LIMITATIONS Vision and hearing problems10 MEDICAL CONDITIONS Hypertension, diabetes, heart attack11 FUNCTIONALITY Need help in 1> ADLs, Need help in 2> IADLs

+Subjects 65 and older Mexican-Americans from the Hispanic Established

Populations for Epidemiologic Studies of the Elderly Wave 1 (1994-1995) and Wave 5 (2004-2005)

Mexicans from the Mexican Health and Aging Study (MHAS) Wave 1 (2001) and Wave 3 (2012)

With Normal cognition at Wave 1 Cognitive function was assessed using the MMSE in the

HEPESE and the CCCE in the MHAS HEPESE: Based on age and educational level, subjects with

scores above the 1st quartile were classified as normal MHAS: Based on the CCCE norms for age and education

FLOW CHART OF SAMPLE SELECTION

Selectivity of the followed-up

DIED> Men> Age< Educated>Migrated

LOST>Women>Age>Educated>Migrated

+COGNITIVE STATUS AFTER 10 YEARSMHASCognitive Normal: 76.7%Cognitive Impaired: 23.3%

HISPANIC EPESECognitive Normal: 66.7%Cognitive Impaired: 33.3%

+COGNITIVE IMPAIRMENTAFTER 10 YEARSMHASMEN: 21.2%WOMEN: 24.9%

HISPANIC EPESEMEN: 37.4%WOMEN: 31.0%

Predictor variables

Predictor variables (cont.)

Odds of Cognitive ImpairmentMHAS HEPESE

Age 2.58** 1.85*Education 0.98* 0.94*Age of Migration (<18 yrs) - 3.25**Not Married 1.54** -Employed 1.37* -Never Worked - 2.59**No Health service 2.78* -Money problems for medical care - 1.39*Diabetes 1.78** 1.56**CVD 2.92** -Vision Limitations 1.65** 1.47*Hearing Limitations - 2.33*Functional impairment IADLs 2.75** 4.4**

Odds Cognitive Impairment by SexMEN WOMEN

RESULTS: PREDICTOR VARIABLES1. SOCIODEMOGRAPHICS AND

EDUCATIONAL ATTAINMENTMHASHEPESE

Age effect (men and women)Age effect (men)Education (women)

2 MIGRATION HEPESE Age of migration <18 yrs (men)3 FAMILY AND SOCIAL NETWORKS MHAS Not married (men)4 PSYCHOLOGICAL FACTORS MHAS External locus of control (men)

Religion not important (women)5 OCCUPATION HEPESE Never worked (men)6 ACCESS TO HEALTH MHAS

HEPESENo health service (women)No money for health care (women)

7 HEALTH BEHAVIORS9 SENSORY LIMITATIONS MHAS

HEPESEVision and Hearing limitations (women)

10 HEALTH CONDITIONS MHASHEPESE

Diabetes (women) CVD (men)Diabetes (women)

11 FUNCTIONALITY HEPESE IADLs (women)

+ConclusionsThe proportion of elders that showed cognitive decline after a 10-year period is higher among Mexicans in the US (33%) than among Mexicans in Mexico (23%). The rate is higher in women among the Mexicans living in Mexico and its higher in men among Mexican-Americans.This result is in agreement with other studies that show a health disadvantages in the migrant community due to negative acculturation.

+ConclusionsA common pattern of risk factors between groups on the "strong”variables

Different pattern related to social variables

Gender effect in strong and social variables

+ConclusionsEducational attainment has been frequently reported as a risk factor for cognitive impairment and dementia. The functional and brain reserve hypothesis has been used to explain how low educated individuals have a less well prepared brain to face aging. Mexican American women had the higher education level (5.75 years)Sensory impairment has also been shown to have an effect in reducing the opportunities that individuals have of adequate cognitive stimulation.

+ConclusionsDiabetes: is also a very important predictor of cognitive impairment. We have published some results before showing that it increases the risk of dementia 2 times compared with non-diabetic individuals.

Diabetes can cause microvascular disease and an increase in insulin resistance affecting brain function

Occupation Status: (Never worked) lack of cognitive stimulation, social engagement, health issues?No Health Access: Risk factor for cognitive impairment

+Conclusions (cont.) Not being married was a predictor of

cognitive decline only among Mexican men. Several studies have reported a protective

effect of being married on the risk of dementia.

For Mexican-americans, the community context which also others called the barrio effect protects for cognitive decline regardless of marital status.

+Conclusions (cont.)The Importance of religion/Attendance at mass, for cognitive decline has been mentioned on a paper by Hill and colleagues who discuss their results in terms of the social engagement it implies.In our study this was only true for Mexican women, however only 1.4% of the women did not considered religion as important and most of these women were cogntively impaired

+Conclusions (cont.)The result of functional impairment as a predictor variable for cognitive decline is a very important result due to the timing it shows. Needing help to carry out the instrumental activities of daily living is happening before cognitive impairment in Mexican-American women. Negative Acculturation?

+

Final

Cognitive decline is not ONLY explained by strong variables as age, health conditions and health access.Migration variables as well as social and psychological variables had an effect on cognitive decline.There is gender effect on “strong”and non-strong variables”A Negative acculturation explanation?

Conclusions

+THANK YOU

smejia@colef. mx