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Latinos: HCHS/SOL Results Neil Schneiderman10 Diabetes Care 2018;41:1501–1509 | Diabetes Care Volume 41, July 2018 1501 Hector M. Gonzalez,´ 1 Wassim Tarraf,2 Metabolic Syndrome and Priscilla Vasquez,´ 1 Ashley H. Sanderlin,3 Natalya I. Rosenberg,4 Sonia Davis,5 Neurocognition Among Diverse Carlos J. Rodr´ıguez,6 Linda C. Gallo,7 Bharat Thyagarajan,8 Martha Daviglus,4 Middle-Aged and Older Hispanics/ Tasneem Khambaty,9 Jianwen Cai,5 and Latinos: HCHS/SOL Results Neil Schneiderman10 Diabetes Care 2018;41:1501–1509 | https://doi.org/10.2337/dc17-1896 OBJECTIVE Hispanics/Latinos have the highest risks for metabolic syndrome (MetS) in the U.S. and are also at increased risk for Alzheimer disease. In this study, we exam- ined associations among neurocognitive function, MetS, and inflammation 1Department of Neurosciences and Shiley- ’ among diverse middle-aged and older Hispanics/Latinos. Marcos Alzheimer s Disease Research Center, University of California, San Diego, La Jolla, CA 2Institute of Gerontology and Department of RESEARCH DESIGN AND METHODS Healthcare Sciences, Wayne State University, Cross-sectional data (2008–2011) from theHispanic Community Health Study/Study Detroit, MI of Latinos (HCHS/SOL) were analyzed to examine associations between neuro- 3Section of Gerontology and Geriatric Medicine, cognition and MetS among diverse Hispanics/Latinos (N = 9,136; aged 45–74 years). Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 4Institute for Minority Health Research, College RESULTS of Medicine, University of Illinois at Chicago, MetS status was associated with lower global neurocognition, mental status, verbal Chicago, IL learning and memory, verbal fluency, and executive function. Age significantly 5Collaborative Studies Coordinating Center, De- modified the associations between MetS and learning and memory measures. partment of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC Significant associations between MetS and neurocognition were observed among 6Departments of Medicine and Epidemiology, CARDIOVASCULAR AND METABOLIC RISK middle-aged Hispanics/Latinos, and all associations remained robust to additional Wake Forest School of Medicine, Winston-Salem, covariates adjustment. NC 7Institute for Behavioral and Community Health CONCLUSIONS and Graduate School of Public Health, San Diego State University, San Diego, CA WefoundthatMetSwasassociatedwithlowerneurocognitivefunction,particularly 8Department of Laboratory Medicine and Pathol- inmidlife.Ourfindingssupportandextendcurrenthypothesesthatmidlifemaybea ogy, University of Minnesota Medical Center particularly vulnerable developmental period for unhealthy neurocognitive aging. Fairview, Minneapolis, MN 9Department of Psychology, University of Mary- land, Baltimore County, Baltimore, MD 10Department of Psychology, University of Miami, The metabolic syndrome (MetS) is a cluster of five overlapping risk factors for diabetes, Coral Gables, FL heartdisease,andneurocognitiveimpairmentanddisorders(1,2).MetSemergesinmid- Corresponding author: Hector M. Gonzalez,´ life and is related to the development of diabetes, heart disease, and stroke (3). MetS [email protected]. affects about one-third of U.S. adults and occurs earlier and more commonly among Received 11 September 2017 and accepted 7 Hispanics/Latinos compared with other racial/ethnic groups (4). Like MetS, neuro- April 2018. cognitive decline, mild cognitive impairment, and Alzheimer disease and related de- This article contains Supplementary Data online mentias (ADRD) are currently thought to emerge in midlife and progress with age (5–7). at http://care.diabetesjournals.org/lookup/ Although age and apoE4 genotypes are leading risks of ADRD, they are not modifiable. suppl/doi:10.2337/dc17-1896/-/DC1. Thus, there is heightened interest in preventing neurocognitive decline and ADRD by © 2018 by the American Diabetes Association. identifying and modifying cardiovascular disease (CVD) risks earlier in the life course. As Readers may use this article as long as the work is properly cited, the use is educational and not such, MetS prevention and control may also serve as effective means for reducing not only for profit, and the work is not altered. More infor- CVD, but also potentially neurocognitive decline and dementias (8), particularly among mation is available at http://www.diabetesjournals Hispanics/Latinos who are at high risk for MetS, ADRD, and low health care access (9). .org/content/license. 1502 Metabolic Syndrome and Neurocognitive Function Diabetes Care Volume 41, July 2018 Previous MetS studies reported asso- to this age-group given the age distribu- assistants. Four neurocognitive tests ciations with neurocognitive impairment tions of Hispanics/Latinos in the four com- were used in this study: 1)Six-Item and ADRD in older adults (10,11), but munitiesofinterest.Adetaileddiscussion Screener (SIS) (18), 2) Brief Spanish En- principally among those with high levels of the study objectives, design, and im- glish Verbal Learning Test (B-SEVLT) ofinflammatorybiomarkers(12–14).Less plementation has been published else- (19,20), 3) Word Fluency (WF) test of is known about middle age, when MetS where (16,17). the Multilingual Aphasia Examination emerges and neurocognitive function is (21,22), and 4) Digit Symbol Subtest thought to become vulnerable (8,15). In Neurocognitive Tests (DSS) (23). Three neurocognitive tests terms of primary prevention, middle age Neurocognitive tests were administered were only available in English (SIS, WF, is likely when effective behavioral and in quiet testing rooms in each of the andDSS).Therefore,theyweretranslated pharmacological interventions are indi- four HCHS/SOL clinics. Participants were by a certified translator and reviewed by cated to arrest MetS from further de- tested in their preferred language (En- the HCHS/SOL Translation Committee veloping into diabetes, CVD events, and glish or Spanish) during face-to-face in- to ensure the Spanish translations were brain pathologies; that is, provided ad- terviews by trained, bilingual research appropriate for diverse, Pan-American equate health care is available, especially to the most vulnerable populations. — In this study, we examined associa- Table 1 Characteristics of the HCHS/SOL target population by MetS status tions among neurocognitive function, No MetS MetS Total (n = 4,270) (n = 4,866) (n = 9,136) P value MetS, and inflammation among diverse middle-agedandolderHispanics/Latinos. Sex (%) Given that current opinions suggest that Female 52.9 56.3 54.7 0.0221 neurocognitive decline and ADRD pathol- Education (%) 0.000 Less than HS 35.0 43.4 39.5 ogy begins in midlife, we sought to com- HS or equivalent 21.7 20.7 21.2 pare midlife and later life associations More than HS 43.3 35.9 39.3 among neurocognitive function, MetS, Background (%) 0.0039 and inflammation in this important and Dominican 9.8 8.4 9.0 vulnerable population of Hispanics/Latinos. Central American 6.4 6.7 6.6 Cuban 25.2 29.9 27.7 RESEARCH DESIGN AND METHODS Mexican 32.8 29.4 30.9 Puerto Rican 17.5 18.7 18.1 Study Sample South American 6.2 4.7 5.4 We used data from the Hispanic Com- Other 2.1 2.3 2.2 munity Health Study/Study of Latinos Language preference (HCHS/SOL). The HCHS/SOL is a large, Spanish 83.3 88.3 86.0 0.000 epidemiological study of Hispanic/Latino Antihypertensives (%) men and women from diverse back- Yes 12.5 39.9 27.3 0.000 grounds.Recruitmentanddatacollection Antidiabetics (%) occurred between 2008 and 2011 and Yes 4.9 26.7 16.7 0.000 included 16,415 participants from four Age, years (mean) 54.8 (9.4) 57.8 (9.9) 56.5 (9.9) 0.000 major U.S. communities (Bronx, NY; Chi- CES-D-10 (mean) 7.2 (7.7) 7.8 (7.9) 7.5 (7.8) 0.001 cago, IL; Miami-Dade, FL; and San Diego, MetS components (%) 0.000 CA) with known large Hispanic/Latino Abdominal obesity 67.5 100.0 85.0 concentrations. Study participants were Impaired TG 13.9 59.2 38.3 sampled to ensure representation of Impaired HDL 15.1 60.0 39.2 Hispanic/Latino adults, aged 18–74 years Impaired BP 35.7 76.3 57.6 at recruitment into the study, in the tar- Impaired fasting glucose 23.9 73.3 50.5 get populations. Sample size was set to MetS components count (%) 0.000 None 8.6 0.0 4.0 allow for appropriate inferences to six 1 33.4 0.0 15.4 major Hispanic/Latino groups, including 2 52.9 0.0 24.4 Dominicans, Central Americans, Cubans, 3 3.7 48.6 27.8 Mexicans, Puerto Ricans, South Ameri- 4 1.4 34.4 19.2 cans, and other. Briefly, the HCHS/SOL 5 0.0 17.1 9.2 was designed to collect detailed demo- MetS components sum (mean) 1.6 (0.9) 3.7 (0.9) 2.7 (1.6) 0.000 graphic, sociocultural, and health data Cognitive outcomes through survey questionnaires and rich B-SEVLT-sum (mean) 22.9 (6.9) 22 (6.8) 22.4 (6.9) 0.000 biological specimens (e.g., blood and B-SEVLT-recall (mean) 8.2 (3.6) 7.9 (3.5) 8.1 (3.5) 0.000 urine) from consenting participants. WF (mean) 19.2 (9) 17.6 (8.6) 18.3 (8.8) 0.000 DSS (mean) 36.1 (16.7) 32 (15.8) 33.9 (16.4) 0.000 The design of the study included a two- Global cognition (mean) 51.1 (11.3) 49.3 (11.2) 50.2 (11.3) 0.000 stage probability sampling approach SIS #4 (%) 14.1 17.5 16.0 0.003 that oversampled adults 45–74 years MetS and its components are defined using the IDF specifications. HS, high school. of age to allow appropriate inferences care.diabetesjournals.org Gonzalez´ and Associates 1503 Latinos. In addition, the Neurocognitive for HDL abnormalities; 3) elevated blood To examine differential effects due to Reading Center principal investigator pressure (BP) (systolic BP $130 mmHg or inflammation, we used a joint modeling (H.M.G.) reviewed the original and trans- diastolic BP $85 mmHg), based on the approach (equivalent to split modeling lated tests to ensure translation accuracy average of three 1-min separated BP for stratified analyses) interacting inflam- and test fidelity.
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