Abstract

Objective

Black adults are diagnosed with Alzheimer’s disease (AD) at higher rates than White adults. Biopsychosocial risk factors that differentially affect individuals by race, including health, education, and APOE e4, may explain these findings. Some research suggests that the risk for AD associated with the APOE e4 allele may differ by race. Gender differences in AD have also been identified but remain understudied. We examined race, APOE status, vascular risk factors, education, and the interaction of APOE e4 status and race as predictors of cognitive decline and the development of Alzheimer’s disease between genders in a large longitudinal sample of older adults. Methods: Participants (N = 4336) were selected from the National Alzheimer’s Coordinating Center’s Uniform Data Set who completed measures of verbal fluency, naming, and immediate/delayed story memory across 5 years. Analyses were stratified by gender. Follow up interactions examined statistical significance of differences. Results: APOE e4 by race interactions were largely non-significant and dropped from most models. When controlling for health, education, referral source, and Uniform Data Set form (when applicable), few racial differences in cognitive performance over time emerged. Black participants obtained lower scores than White participants on a majority of baseline measures. Race findings did not differ by gender. Hypertension was more strongly predictive of decline in delayed memory among women. Conclusions: Analyses did not support that APOE e4 differentially affects Black individuals. Hypertension may be a more relevant risk factor among women. Results raise questions regarding the accuracy of baseline scores in predicting decline for Black individuals.

 抽象的

 客观的

黑人成年人被诊断出患有阿尔茨海默病 (AD) 的比例高于白人成年人。生物心理社会风险因素对不同种族的个体有不同的影响，包括健康、教育和 APOE e4，可能可以解释这些发现。一些研究表明，与 APOE e4 等位基因相关的 AD 风险可能因种族而异。 AD 中的性别差异也已被发现，但仍未得到充分研究。我们在大量老年人纵向样本中研究了种族、APOE 状态、血管危险因素、教育程度以及 APOE e4 状态和种族之间的相互作用，作为性别之间认知能力下降和阿尔茨海默病发展的预测因素。方法：参与者 (N = 4336) 是从国家阿尔茨海默病协调中心的统一数据集中选出的，他们在 5 年内完成了言语流畅性、命名和即时/延迟故事记忆的测量。分析按性别分层。后续相互作用检查了差异的统计显着性。结果：种族相互作用的 APOE e4 基本上不显着，并且从大多数模型中删除。当控制健康、教育、推荐来源和统一数据集表格（如果适用）时，随着时间的推移，认知表现方面几乎没有出现种族差异。在大多数基线测量中，黑人参与者的得分低于白人参与者。种族调查结果并没有因性别而异。高血压更能预测女性记忆力延迟下降。结论：分析并不支持 APOE e4 对黑人个体有不同的影响。高血压可能是女性更相关的危险因素。结果提出了关于预测黑人衰退的基线分数准确性的问题。