Approximately 10% of American adults aged 45 and older self-reported cognitive decline between 2015 and 2020, especially among American Indian and Alaska Native adults. However, less than half of these adults discussed their concerns with their health care providers. These are the findings of a study published in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
Researchers in the United States analyzed the differences in self-reported cognitive decline between various racial and ethnic groups in the United States between the years 2015 and 2020.
They calculated that 9.6% of adults aged 45 and older in the US self-reported cognitive decline. Approximately 16.7% of non-Hispanic American Indian or Alaska Native adults, 11.4% of Hispanic adults, 10.1% of Black adults, 9.3% of White adults, and 5.0% of Asian or Pacific Islander adults reported that they were experiencing cognitive decline. Based on prevalence trends, Black and Hispanic adults are projected to have the largest increase in cognitive decline by 2060.
Modifiable risk factors for Alzheimer disease or a related dementia (ADRD) include high blood pressure, insufficient physical activity, diabetes, obesity, depression, smoking status, and hearing loss. College education decreased prevalence of subjective cognitive decline across all racial and ethnic groups.
Increasing age correlated with increasing subjective cognitive decline, particularly for individuals aged 75 and older; however, adults with health insurance reported less cognitive decline compared with those who did not have health insurance (9.5% vs 11.6%). Geographically, southern states, including Alabama, Louisiana, West Virginia, Tennessee, Florida, Oklahoma, and New Mexico demonstrated higher prevalence of subjective cognitive decline.
Less than half of these adults (47.3%) discussed their concerns of confusion or memory loss with their health care providers, decreasing the chances of early intervention for potentially treatable contributing conditions or modification of lifestyle risk factors. Women were more likely to talk about cognitive decline with their providers than men (50.7% vs 43.3%).
“The findings of this study can help health care providers identify groups of patients who would benefit from risk reduction behaviors and further cognitive assessment,” the researchers noted.
They concluded that “Although dementia might not be preventable for some, the risk for developing dementia for others can be delayed or reduced through early interventions and public health education including heart-healthy lifestyles, protecting the head from traumatic brain injury, and engaging in social activities.”
Study limitations included small sample sizes for some racial and ethnic groups, especially at the state level; lack of generalizability to institutionalized adults; and reliance on self-reported cognitive decline instead of documented medical examinations, which introduces the possibility of recall and social desirability biases.
Wooten KG, McGuire LC, Olivari BS, Jackson EMJ, Croft JB. Racial and ethnic differences in subjective cognitive decline – United States, 2015-2020. MMWR Morb Mortal Wkly Rep. Published online March 10, 2023. doi:10.15585/mmwr.mm7210a1