1. Columbia University Medical Center
WHICAP Washington Heights/Hamilton Heights-Inwood Columbia Aging Project
Jennifer J. Manly, PhD
Columbia University Medical Center

2. Acknowledgements
Funded in part by Grant R13AG A1 from the National Institute on Aging
The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

3. Supported by Collaborators
Maria Glymour Christopher Weiss Adam Brickman Karen Siedlecki Robert Heaton
Lenny Cedano
Raquel Cabo
Yaakov Stern
Richard Mayeux
Nicole Schupf
Supported by
NIA R01 AG16206 (PI: Manly)
NIA P01 AG07232 (PI: Mayeux)

4. Spanish or English speaking Seen in home at 18 – 24 month intervals
PI: Richard Mayeux
INWOOD
WASHINGTON HEIGHTS
HAMILTON HEIGHTS
N = 2125 in 1992
Added 2174 in1999 to total 2801
Age 65 and older
Spanish or English speaking
Seen in home at 18 – 24 month intervals
Dx based on neuropsychological test battery, medical & functional interview

5. Age-Specific Incidence of Alzheimer’s Disease
Annual age-specific incidence
Tang et al., 2001; Neurology 56: 49-56

6. Underlying all comparisons of test performance between racial/ethnic groups is the fallacy imbedded in racial/ethnic classifications: that there is a biological or genetic basis for race.

7. RACE
“ An inbreeding, geographically isolated population that differs in distinguishable physical traits from other members of the same species.”
Zuckerman, 1990; p. 1297

8. Hypertension & SES
Research shows that the higher rates of hypertension among African Americans as compared to Whites “persists” after adjusting for traditional indicators of SES (e.g., years of education, income)
Genes for hypertension unique to African Americans are being sought

9. Hypertension & SES
Accounting for assets, debt, use of public assistance, and neighborhood-level indicators of income explains racial differences in hypertension Cooper & Kaufman, 1998; Kaufman et al., 1997
Perceived discrimination and residential segregation perception of discrimination have significant associations with hypertension Krieger, 1999; Williams, 1997; Williams & Neighbors, 2001; Williams, Neighbors, & Jackson, 2003; Williams, Massing, Rosamond, Sorlie, & Tyroler, 1999; Wyatt et al., 2003

10. Race
Used as a proxy for assumed educational, socioeconomic, biological, or behavioral differences
Diversity within ethnic groups:
Educational
Linguistic
Geographic
Economic
Exposure to Mainstream culture
Racial classification is fluid over time and place

11. DECONSTRUCTING RACE AND EDUCATION
Assume these variables are proxies for more meaningful underlying factors
Determine which aspects of the variable are expected to affect test performance
Premorbid
Change over time
Determine relationship to test performance
Adjust for significant factors before interpreting scores, regardless of race

12. MCI in an ethnically and educationally diverse cohort
Most MCI studies are clinic-based Caucasian, well educated participants
How can MCI criteria be operation among ethnically, linguistically, and educationally diverse elders?
What implications do the use of robust norms in this diverse sample have on MCI prevalence and outcomes?

13. No significant ethnic differences in frequency of MCI
Percent
Manly et al, Arch Neurol (2005)

14. Length of School Term

15. Proportion of variance in cognitive test scores explained by state of elementary education
Manly, Glymour, and Weiss (in preparation)

16. English Reading Level Wide Range Achievement Test - reading subtest
I V Z J Q
see red milk was
between cliff stalk grunt
clarify residence urge rancid
conspiracy deny quarantine deteriorate
regime beatify internecine regicidal
puerile factitious lucubration
epithalamion inefficacious synecdoche

17. READING LEVEL AND YEARS OF EDUCATION

18. ETHNICITY, GRADE, AND READING LEVEL

19. Reading ability accounts for ethnic group differences
** p < .01; *** p < .001
Manly et al, 2002, J Int Neuropsychol Soc 8:

20. Reading ability accounts for ethnic group differences
* p < .05; ** p < .01
Manly et al, 2002, J Int Neuropsychol Soc 8:

21. Determinants of cross-sectional language test performance
***
***
***
***
***
***
***
***
All models are adjusted for age and sex

22. Literacy and Memory
Manly et al., JCEN 2003

23. Race, education, literacy, & incident AD
***
***
***
Relative Risk
*** **
** p < .01; *** p < .001

25. Spanish Reading Level Word Accentuation Test
ACULLA
ABOGACIA
ANOMALO
CELIBE
ALELI
RABI
APATRIDA
HUSAR
ALEGORIA
MANCHU
DIAMETRO
MOARE
CONCAVO
AMBAR
PUGIL
POLIGAMO
ACME
SILICE
GRISU
ALBEDRIO
CANON
PIFANO
TACTIL
VOLATIL
DESCORTES
DISCOLO
BULGARO
BALADI
ACOLITO
CUPULA
Del Ser et al., 1997

26. Predicting Incident AD among Hispanic Immigrants n = 670
Model 1
Model 2
Model 3
Model 4
Variables in the Model B
p value
Age
.103
.000
.106
.107
Sex
.189
.352
.208
.307
.169
.410
.206
.330
.230
.280
Years of education
-.073
.002
-.065
.009
-.051
.046
.033
.038
.209
Dominican vs. other
-.238
.242
-.110
.608
-.038
.865
.840
Time in the US
-1.225
.060
-1.055
.113
-.669
.350
Spanish Reading
-.082
-.081
English Fluency
.381
.140

27. Sensitivity and specificity of self-reported stroke
All vascular territories
32.4
78.9
Large infarcts
51.5
78.1
Small infarcts
28.5
76.6
Cortical infarcts
40.0
76.3
Subcortical infarcts
33.1
77.3
717 nondemented elders scanned
225 persons had a brain infarct on MRI
Reitz et al., submitted

28. Age, ethnicity, and relative WMH volume
Brickman et al., in press