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Related Experiment Video

Updated: Jun 21, 2025

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
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Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear

Sean A P Clouston1,2, Douglas W Hanes1, Dylan M Smith1,2

  • 1Program in Public Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|July 13, 2024
PubMed
Summary

Addressing observational window bias in Alzheimer's disease and related dementias (ADRD) research reveals significant social inequalities. Educational disparities and race impact the onset of accelerated cognitive decline, highlighting inequities in ADRD risk.

Keywords:
Alzheimer's and related diseasescognitive pathologylongitudinal cognitive declineparametric segmented modeling

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Area of Science:

  • Neuroscience
  • Public Health
  • Sociology

Background:

  • Observational window bias complicates studies on educational differences in Alzheimer's disease and related dementias (ADRD) risk.
  • Previous research has yielded conflicting results due to limitations in observing the period preceding accelerated cognitive decline.

Purpose of the Study:

  • To introduce a novel model addressing observational window bias in ADRD research.
  • To investigate the presence and origins of disparities in accelerated cognitive decline indicative of ADRD.

Main Methods:

  • Utilized a large dataset of 167,314 cognitive assessments from 32,441 Health and Retirement Study participants.
  • Implemented a parametric non-linear nested longitudinal regression model.
  • Reported multivariable-adjusted nodal incidence ratios (aNIR) to quantify risk.

Main Results:

  • University degrees were associated with a 74.7% lower incidence of accelerated cognitive decline (aNIR = 0.253, p < 0.001).
  • Black participants exhibited a 99.5% higher incidence of accelerated cognitive decline (aNIR = 1.995, p < 0.001), even after adjusting for covariates.
  • Sex-stratified analyses revealed reduced educational benefits for women and increased incidence among minoritized women.

Conclusions:

  • The novel approach effectively mitigates observational window bias, uncovering substantial social inequalities in ADRD onset.
  • Findings demonstrate significant educational and racial/ethnic disparities in the preclinical phase of ADRD.
  • The study highlights the intersectionality of sex/gender with race and education in ADRD disparities.