Objectives: Responding to racial/ethnic disparities in dementia diagnosis and care, we examined the role of race/ethnicity in the correspondence between subjective and objective ratings of cognitive impairment. Our examination focused on the two types of discordance: (1) positive ratings in the presence of cognitive impairment and (2) negative ratings in the absence of cognitive impairment. Design and Participants: A cross-sectional assessment was conducted using the data from the Harmonized Cognitive Assessment Protocol project, a sub-study of the Health and Retirement Study. Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics. Measurements: Discordant groups were identified based on self-ratings of cognition (positive versus negative) and the Langa–Weir classification of cognitive impairment (normal versus impaired). Results: Blacks and Hispanics were more prone to falsely positive perceptions of their cognitive function in the presence of cognitive impairment than non-Hispanic Whites. On the other hand, non-Hispanic Whites were more likely to manifest negative ratings even in the absence of cognitive impairment. Conclusion: Our findings demonstrate the critical role of race/ethnicity in determining discordance between subjective and objective measures of cognition and highlight the importance of a tailored effort to promote dementia diagnosis and care.
Bibliographical noteFunding Information:
The data for the present investigation came from the Harmonized Cognitive Assessment Protocol (HCAP) project, a sub-study of the Health and Retirement Study (HRS). The HRS is a US representative panel study of adults aged 50 years or older, conducted biannually since 1992. The HRS is sponsored by the National Institute on Aging (grant number U01 AG009740) and is conducted by the University of Michigan. The HCAP includes a randomly selected sub-sample of HRS respondents aged 65 years or older who completed the 2016 core interview. Between June 2016 and October 2017, one-hour-long face-to-face surveys were carried out. The HCAP study protocols were approved by the University of Michigan Institutional Review Board. More information on the HCAP is available elsewhere. 19 A total of 3,496 eligible individuals completed the interview, with a response rate of 79%. For the present investigation, respondents who were institutionalized, with proxy interviews, and with a race/ethnicity other than non-Hispanic White, Black, or Hispanic were excluded. Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics.
© 2021 American Association for Geriatric Psychiatry
- cognitive impairment
- racial and ethnic minorities
- Self-rated cognition