Page 51 - Encyclopedia of Nursing Research

18 n ALZHEiMER’S DiSEASE

and African Americans more than 31% com- cognitive, and functional ability and the every-
pared with a 15% increase in Anglos, these day lives of individuals. in addition, the theo-
A projections of cognitive decline are alarming. retical paradigms that investigators choose to
of those adults 65 years and older enrolled guide their inquiries also systematically neces-
in the Health and Retirement Study, 12.7% of sitate ongoing evaluation (McDougall, 1995a,
both sexes had moderate or severe memory 1995b; McDougall, & Becker, Arheart, 2006).
impairment defined as four or fewer words in addition, understanding the impact of cul-
recalled out of 20 on combined immediate ture and social class on cognitive function
and delayed recall tests (Federal interagency and other important health outcomes requires
Forum of Aging-Related Statistics, 2006). research that takes a broader perspective and
Unknown from this longitudinal data was identifies intervening factors that affect mem-
the source of the memory impairment. What ory performance.
is known is that racial and ethnic minorities, Ethnicity, race, and culture are impor-
females, older persons, and persons with tant considerations in cognitive aging. After
limited education are at higher risk for both examining the relationship between memory
obesity and cognitive decline. performance and SES, a positive correlation
Despite uniform detection methods and between memory performance and SES
controlling for reported duration of dementia was observed, although there was no suf-
symptoms, measured cognitive impairment ficient evidence to show that SES is not dif-
is significantly more severe when AD is rec- ferentially related to memory performance
ognized in Blacks compared with Whites (Espino, Lichtenstein, Palmer, & Hazuda,
(McDougall, vaughan, Acee, & Becker, 2007). 2001; Herrmann & Guadagno, 1997).
in a sample of Black and White community older Latinos had a mean age at Alzheimer
elderly, age and race were statistically signifi- symptom onset 6.8 years earlier than did
cant predictors of memory performance in the Anglos. of 89 Mexican American elders who
multiple regression analysis, even accounting were seen in an outpatient memory evaluation
for education, depression, gender, and mem- clinic, they had greater than expected mod-
ory complaints (Shadlen, Larson, Gibbons, erate and severe memory impairment, high
McCormick, & Teri, 1999). The rate of decline levels of instrumental activities of daily living
in Blacks with AD may be slower than that impairments (83%), and high levels of depres-
in Caucasians. Researchers from the Chicago sive symptoms (63%). older Mexican-origin
Health and Aging Project demonstrated that cohorts have very low levels of education, a
greater social resources, as defined by social risk factor for AD. in the Hispanic Established
networks and social engagement, were associ- Populations for Epidemiological Studies of
ated with reduced cognitive decline in old age the Elderly study, only 35.6% of the Mexican
among 6,102 Black elderly (Barnes, Mendes de American elderly sample were not cognitively
Leon, Wilson, Bienias, & Evans, 2004). These impaired by passing both the Mini-Mental
relationships remained after controlling for State Examination (MMSE) and the execu-
socioeconomic status (SES), cognitive activity, tive clock-drawing task. in the Sacramento
physical activity, depressive symptoms, and valley epidemiological study of older Latinos,
chronic medical conditions. Education has dementia prevalence was 4.8% but reached 31%
particular relevance for Black and Hispanic in those 85 years and older (Black et al., 1999;
elderly, who often have less formal education Espino et al., 2002; Haan et al., 2003; Royall,
than their White counterparts and are partic- Espino, Polk, Palmer, & Markides, 2004).
ularly afraid of cognitive or mental disorders. The Duke Established Populations for
Nursing research investigates not only the Epidemiological Studies of the Elderly study
screening, assessment, and diagnosis of AD but noted that cognitive problems were diffi-
also the impact of the disease on the affective, cult to recognize in Hispanic families. When