Prospective Associations of Erythrocyte Composition and Dietary Intake of n-3 and n-6 PUFA with Measures of Cognitive Function.

Polyunsaturated fatty acid (PUFA) consumption is recommended as part of a healthy diet, but evidence of the impact of individual species and biological concentrations on cognitive function is limited. We examined prospective associations of PUFA erythrocyte composition and dietary intake with measures of cognitive function among participants of the Boston Puerto Rican Health Study (aged 57 years). Erythrocyte and dietary PUFA composition were ascertained at baseline and associated with 2-year scores on the Mini-Mental State Exam (MMSE) (n = 1032) and cognitive domain patterns derived from a battery of tests (n = 865), as well as with incidence of cognitive impairment. Erythrocyte and dietary n-3 PUFA were not significantly associated with MMSE score. However, total erythrocyte and dietary n-3 very-long-chain fatty acids (VLCFA), and intake of individual species, were associated with better executive function (P-trend < 0.05, for all). There was evidence that greater erythrocyte n-6 eicosadienoic acid concentration was associated with lower MMSE and executive function scores (P-trend = 0.02). Only erythrocyte arachidonic acid (ARA) concentration predicted cognitive impairment (Odds Ratio = 1.26; P = 0.01). Among Puerto Rican adults, we found that n-3 VLCFA consumption may beneficially impact executive function. Further, these findings provide some evidence that n-6 metabolism favoring greater ARA tissue incorporation, but not necessarily dietary intake, could increase the risk of cognitive impairment.

Parental history of moderate to severe infantile malnutrition is associated with cognitive deficits in their adult offspring.

OBJECTIVES: We compared the IQ and academic achievement of the young adult offspring of parents malnourished in infancy and those of a healthy control group in order to test the hypothesis that the offspring of previously malnourished individuals would show IQ and academic deficits that could be related to reduced parental socioeconomic status. METHODS: We conducted a group comparison study based on a community sample in Barbados (Barbados Nutrition Study). Participants were adult children ≥16 years of age whose parents had been malnourished during the first year of life (n = 64; Mean age 19.3 years; 42% male) or whose parents were healthy community controls (n = 50; Mean age 19.7 years; 48% male). The primary outcome was estimated IQ (Wechsler Abbreviated Scale of Intelligence); a secondary outcome was academic achievement (Wide Range Achievement Test - Third Edition). Data were analyzed using PROC MIXED with and without adjusting for parental socioeconomic status (Hollingshead Index of Social Position). RESULTS: IQ was reduced in the offspring of previously malnourished parents relative to the offspring of controls (9.8 point deficit; P < 0.01), but this difference was not explained by parental socioeconomic status or parental IQ. The magnitude of the group difference was smaller for basic academic skills and did not meet criteria for statistical significance. DISCUSSION: The deleterious impact of infant malnutrition on cognitive function may be transmitted to the next generation; however, this intergenerational effect does not appear to be explained by the reduced socioeconomic status or IQ of the parent generation.

Influence of nationality on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS).

OBJECTIVE: In answer to the call for improved accessibility of neuropsychological services to the international community, the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS; MS) was validated in multiple, non-English-speaking countries. It was created to monitor processing speed and learning in MS patients, including abbreviated versions of the Symbol Digit Modalities Test, California Verbal Learning Test, 2nd Edition, and the Brief Visuospatial Memory Test, Revised. The objective of the present study was to examine whether participant nationality impacts performance above and beyond common demographic correlates. METHOD: We combined published data-sets from Argentina, Brazil, Czech Republic, Iran, and the U.S.A. resulting in a database of 1,097 healthy adults, before examining the data via multiple regression. RESULTS: Nationality significantly predicted performance on all three BICAMS tests after controlling for age and years of education. Interactions among the core predictor variables were non-significant. CONCLUSION: We demonstrated that nationality significantly influences BICAMS performance and established the importance of the inclusion of a nationality variable when international norms for the BICAMS are constructed.

Determinantes del estado de salud de la población y su influencia en el desarrollo de los trastornos cognitivos / Determinants of the health status of the population and its influence on the development of cognitive disorders

Introducción: Ante el envejecimiento acelerado de la población cubana los trastornos cognitivos se han convertido en creciente problema y un reto para nuestro sistema de salud. Objetivo: Describir la influencia de las determinantes del estado de salud de la población en el desarrollo de los trastornos cognitivos. Fuente de datos: Se consultaron 113 artículos en la Biblioteca Virtual Scielo y en las bases de datos Medline, Google Scholar, Cochrane y PubMed, en idioma Inglés y Español. Se seleccionaron 40, publicados en revistas nacionales e internacionales de gran impacto, por autores considerados expertos en esta temática. Síntesis de los datos: Además de factores biológicos y genéticos, existen determinantes psicosociales como el nivel educacional y los estilos de vida que pudieran incidir en la aparición y desarrollo de las demencias. Entre estos últimos, aparecen los hábitos tóxicos, las relaciones sociales, antecedentes de depresión, nivel socioeconómico y otros. Conclusiones: La influencia de los determinantes del estado de salud de la población en el desarrollo de los trastornos cognitivos, es notable. Es necesario el estudio de estos determinantes y su contribución a la puesta en marcha de estrategias de intervención comunitaria que ayuden, sobre todo, a la población más vulnerable a tener una mejor calidad de vida(AU).

Introduction: The accelerated aging of the Cuban population is an alert to the high prevalence of dementias and other chronic diseases. Objective: To describe the influence of health status determinants of the population in the development of cognitive disorders. Data source: 113 articles in the Scielo Virtual Library and in Medline, Google Scholar, Cochrane and PubMed databases were consulted, both in English and Spanish. 38 of the selected were published in national and international magazines of great impact, by authors considered experts in this subject. Synthesis of data: In addition to biological and genetic factors, there are other psychosocial determinants such as education and lifestyles that may have an impact on the onset and development of dementia. Among the latter are toxic habits, social interactions, sleep, and depressive states. These states may be considered as a psychological reaction to incipient cognitive worsening or as an early manifestation of dementia. Conclusions: The influence of population´s health status determinants in the development of cognitive disorders is remarkable. Given the accelerated aging of the Cuban population, cognitive disorders become a growing health problem. More research is needed and the results of this may contribute to a better understanding of the epidemiological behavior of these disorders. It is necessary, through intersectoral work, the implementation of community intervention strategies that help above all most vulnerable population to have a better life quality(AU)

Validity of Sluggish Cognitive Tempo in South America: An Initial Examination Using Mother and Teacher Ratings of Chilean Children.

OBJECTIVE: To examine the validity of sluggish cognitive tempo (SCT) and ADHD-inattention (ADHD-IN) symptoms in children from Chile. METHOD: Mothers and teachers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (ADHD-HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection (teachers only) in 652 Chilean children (55% boys) aged 6 to 14 years. RESULTS: For both mother and teacher ratings, the eight SCT symptoms and nine ADHD-IN symptoms showed substantial loadings on their respective factors (convergent validity) along with loadings close to zero on the alternative factor (discriminant validity). ADHD-IN showed a uniquely stronger relationship than SCT with ADHD-HI and ODD whereas SCT showed a uniquely stronger relationship than ADHD-IN with anxiety and depression. Although ADHD-IN uniquely predicted academic impairment and social difficulties, SCT did not. CONCLUSION: This study provides the first evidence for the validity of SCT among children outside of North America or Western Europe.

A new assessment tool for patients with multiple sclerosis from Spanish-speaking countries: validation of the Brief International Cognitive Assessment for MS (BICAMS) in Argentina.

BACKGROUND: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an international assessment tool for monitoring cognitive function in multiple sclerosis (MS) patients. BICAMS comprises the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test - Second Edition (CVLT II) and the Brief Visuospatial Memory Test - Revised (BVMT-R). Our objective was to validate and assess the reliability of BICAMS as applied in Argentina and to obtain normative data in Spanish for this population. METHOD: The sample composed of 50 MS patients and 100 healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients. RESULTS: The sample's average age was 43.42 ± 10.17 years old, and average years of schooling were 14.86 ± 2.78. About 74% of the participants were women. The groups did not differ in age, years of schooling, or gender. The MS group performed significantly worse than the HC group across the three neuropsychological tests, yielding the following Cohen's d values: SDMT: .85; CVLT I: .87; and BVMT-R: .40. The mean raw scores for Argentina normative data were as follows: SDMT: 56.71 ± 10.85; CVLT I: 60.88 ± 10.46; and BVMT-R: 23.44 ± 5.84. Finally, test-retest reliability coefficients for each test were as follows: SDMT: r = .95; CVLT I: r = .87; and BVMT-R: r = .82. CONCLUSION: This BICAMS version is reliable and useful as a monitoring tool for identifying MS patients with cognitive impairment.

Effects of Comorbid Depression and Diabetes Mellitus on Cognitive Decline in Older Mexican Americans.

OBJECTIVES: To assess the relationship between comorbid depression, diabetes mellitus (DM), and cognitive decline in Mexican Americans aged 65 and older. DESIGN: Retrospective cohort study with longitudinal analysis. SETTING: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: Hispanic Established Populations for the Epidemiologic Study of the Elderly. MEASUREMENTS: Cognition was assessed using the Mini-Mental State Examination (MMSE). Depression was defined as a score of 16 or greater on the Center for Epidemiologic Studies Depression Scale. DM was defined as according to self-reported history or taking insulin or oral hypoglycemic medication. RESULTS: Participants with depression and DM declined an average of 6.5 points on the MMSE; depression only, 4.4 points; DM only, 7.8 points; and neither condition, 4.2 points across the six examination waves. Participants with DM declined an average of 0.18 more points on the MMSE per year (P=.001) than those with neither DM nor depression, and those with comorbid DM and depression declined 0.25 more points per year (P=.002). Depression was associated with significantly greater cognitive decline (ß^=-0.11, P=.05) after excluding participants with baseline cognitive impairment (MMSE score≤17). Participants with DM were 1.08 (95% CI=1.03-1.12) times as likely as those with neither DM nor depression, and those with comorbid DM and depression were 1.08 (95% CI=1.01-1.15) times as likely as those with neither DM nor depression to develop severe cognitive impairment per year. CONCLUSION: DM and comorbid depression and DM are risk factors for cognitive decline in older Mexican Americans. Interventions that reduce the prevalence of depression and DM in Mexican Americans may decrease the number of older adults who experience cognitive decline.

Stability in Cognitive Function Over 18 Years: Prevalence and Predictors among Older Mexican Americans.

PURPOSE: Numerous studies have examined the association of physical, behavioral and social factors with cognitive decline in older adults. Less attention has been placed on factors associated with long-term maintenance of intact cognition even into very old age. A greater understanding of those factors can inform the development of activities for maintaining cognitive strength. METHODS: Using a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of non-institutionalized Mexican Americans aged 65 and older from five Southwestern states (N = 2767), latent class mixture models were developed to identify subgroups of cognitive change over time. RESULTS: Three distinct trajectories of cognitive change were identified and characterized as stable, slow decline and rapid decline. Compared to the rapid decline group, a higher proportion of the stable cognition group were women, had high school education, were married and attended church one or more times per week. Regular church attendance had a significant positive impact in the stable group (ß = 0.64, p <0.01), the slow decline group (ß = 0.84, p <0.001) and the rapid decline group (ß = 2.50, p <0.001). Activity limitations had a consistently negative association with cognition in the stable, slow decline and rapid decline groups (ß = -0.37, p <0.001; ß = -0.85, p <0.001; and ß = -1.58, p <0.001 respectively). CONCLUSION: Substantial heterogeneity exists in rates of cognitive decline among older Mexican Americans. Interventions targeting cognitive maintenance may benefit from increased focus on factors associated with continued social engagement.

Does type 2 diabetes increase rate of cognitive decline in older Mexican Americans?

Estimating effects of diabetes on cognitive change among older Mexican Americans is important, yet challenging, because diabetes and cognitive decline both predict mortality, which can induce survival bias. Older Mexican Americans in the Sacramento Area Latino Study on Aging (n=1634) completed Modified Mini-Mental State Exams (3MSE) and diabetes assessments up to 7 times (from 1998 to 2007). We examined baseline and new-onset diabetes and cognitive decline with joint longitudinal-survival models to account for death. At baseline, 32.4% of participants had diabetes and 15.8% developed diabetes during the study. During the study period, 22.8% of participants died. In joint longitudinal-survival models, those with baseline diabetes experienced faster cognitive decline (P=0.003) and higher mortality (hazards ratio=1.88; 95% confidence interval, 1.48-2.38) than those without diabetes. Cognitive decline and mortality were similar for those with new-onset diabetes and those without diabetes. For a typical person, 3MSE scores declined by 2.3 points among those without diabetes and 4.3 points among those with baseline diabetes, during the last 6 years of study. Ignoring the impact of death yielded a 17.0% smaller estimate of the effect of baseline diabetes on cognitive decline. Analyses that overlook the association between cognitive decline and mortality may underestimate the effect of diabetes on cognitive aging.

Cognitive predictors of limited health literacy in adults with heterogeneous socioeconomic backgrounds.

The purpose of this study was to explore the relationship between health literacy and specific cognitive abilities in hospital users. A neuropsychological battery was administered and the Short Test of Functional Health Literacy in Adults was used to classify individuals as having adequate or limited functional health literacy. Of the 322 participants, 102 (31.7%) presented limited health literacy. Even after adjusting for demographics, years of education, and quality of education, health literacy was strongly associated with measures of cognitive performance, but the strength of association was variable across different cognitive abilities.

Global cortical atrophy (GCA) associates with worse performance in the Montreal Cognitive Assessment (MoCA). A population-based study in community-dwelling elders living in rural Ecuador.

BACKGROUND/OBJECTIVE: Increasing numbers of individuals with cognitive impairment are posing economic threads to the developing world. Proper assessment of this condition may be complicated by illiteracy and cross-cultural factors. We conducted a population-based study in elders living in rural Ecuador to evaluate whether the MoCA associated with structural brain damage in less-educated populations. METHODS: Atahualpa residents aged ≥60 years were identified during a door-to-door survey and invited to undergo MRI for grading GCA. Using a multivariate generalized linear model, we evaluated whether MoCA scores correlates with GCA, after adjusting for demographics, education, cardiovascular health (CVH) status, depression and edentulism. RESULTS: Out of 311 eligible persons, 241 (78%) were enrolled. Mean age was 69.2±7.5 years, 141 (59%) were women, 199 (83%) had primary school education, 175 (73%) had poor CVH status, 30 (12%) had symptoms of depression and 104 (43%) had edentulism. Average MoCA scores were 18.5±4.7 points. GCA was mild in 108, moderate in 95, and severe in 26 persons. Total and most domain-specific MoCA scores were significantly worse in persons with moderate to severe GCA. In the multivariate model, mean MoCA score was associated with GCA severity (ß=2.38, SE=1.07, p=0.027). CONCLUSIONS: MoCA scores associate with severity of GCA after adjusting for potential confounders, and may be used as reliable estimates of structural brain damage. However, a lower cut-off than that recommended for developed countries, would be better for recognizing cognitive impairment in less educated populations.

Evaluación preliminar del efecto del Compvit-B sobre procesos de memoria y aprendizaje en pacientes con SCA2 / Preliminary evaluation of the effect of Compvit-B on memory and learning processes in patients with SCA2

INTRODUCCIÓN: la ataxia Espinocerebelosa tipo 2 (SCA2) es una enfermedad neurodegenerativa que alcanza las mayores tasas de prevalencia e incidencia en Holguín, Cuba. Una de las principales manifestaciones clínicas de estos pacientes son los trastornos cognitivos, expresados fundamentalmente como déficits frontoejecutivos y de la memoria. OBJETIVO: evaluar el efecto del tratamiento con vitaminas del Complejo B sobre las funciones cognitivas, en pacientes cubanos con SCA2. MÉTODOS: se incluyeron 20 pacientes en una investigación de intervención clínica, empleando COMPVIT-B, durante 3 meses. Se evaluaron parámetros clínicos, como la escala SARA y cognitivos como el test de Stroop, el test de Fluencia verbal fonológica y el test de memoria verbal. Todos los estudios se realizaron antes y después del tratamiento. RESULTADOS: el estudio de las funciones frontoejecutivas reveló un aumento significativo del número de palabras mencionadas en el test de fluencia verbal fonológica, al terminar el estudio. Sin embargo, el test de Stroop no mostró cambios significativos. En relación al test de memoria verbal, se obtuvo un aumento del número de palabras recordadas en el primer ensayo, así como reducción del número de ensayos requeridos para recordar todas las palabras. La puntuación de la escala SARA no cambió significativamente. CONCLUSIONES: el presente trabajo constituye una evidencia adicional en favor del uso terapéutico y neuroprotector de las vitaminas del complejo B e identifica una nueva opción de tratamiento sintomatológico para los enfermos con SCA2, lo que incide positivamente en el mejoramiento de la calidad de vida de estos pacientes.

INTRODUCTION: Spinocerebellar ataxia type 2 (SCA2) is a neurodegenerative disease with the highest prevalence and incidence rates in the province of Holguín, Cuba. One of its main clinical manifestations is cognitive disorders, fundamentally expressed as frontal-executive and memory deficits. OBJECTIVE: Evaluate the effect of B-complex vitamins on cognitive functions in Cuban patients with SCA2. METHODS: Twenty patients were included in a clinical intervention study based on the use of Compvit-B for 3 months. An evaluation was conducted of clinical parameters such as the Scale for the Assessment and Rating of Ataxia (SARA), and cognitive parameters like the Stroop test, the phonological verbal fluency test and the verbal memory test. All the studies were conducted before and after the treatment. RESULTS: The study of frontal-executive functions revealed a significant increase in the number of words mentioned in the phonological verbal fluency test at the end of the study. However, the Stroop test did not show any significant change. The verbal memory test showed an increase in the number of words recalled in the first assay, and a reduction in the number of assays required to recall all the words. Scores on the SARA did not change significantly. CONCLUSIONS: The paper provides additional evidence in support of the therapeutic and neuroprotective use of B-complex vitamins and presents a new option of symptomatic treatment for patients with SCA2, which will lead to an improvement in their quality of life.

Neurological, functional, and cognitive stroke outcomes in Mexican Americans.

BACKGROUND AND PURPOSE: Our objective was to compare neurological, functional, and cognitive stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites using data from a population-based study. METHODS: Ischemic strokes (2008-2012) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from patient or proxy interviews (conducted at baseline and 90 days poststroke) and medical records. Ethnic differences in neurological (National Institutes of Health Stroke Scale: range, 0-44; higher scores worse), functional (activities of daily living/instrumental activities of daily living score: range, 1-4; higher scores worse), and cognitive (Modified Mini-Mental State Examination: range, 0-100; lower scores worse) outcomes were assessed with Tobit or linear regression adjusted for demographics and clinical factors. RESULTS: A total of 513, 510, and 415 subjects had complete data for neurological, functional, and cognitive outcomes and covariates, respectively. Median age was 66 (interquartile range, 57-78); 64% were MAs. In MAs, median National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living, and Modified Mini-Mental State Examination score were 3 (interquartile range, 1-6), 2.5 (interquartile range, 1.6-3.5), and 88 (interquartile range, 76-94), respectively. MAs scored 48% worse (95% CI, 23%-78%) on National Institutes of Health Stroke Scale, 0.36 points worse (95% CI, 0.16-0.57) on activities of daily living/instrumental activities of daily living score, and 3.39 points worse (95% CI, 0.35-6.43) on Modified Mini-Mental State Examination than non-Hispanic whites after multivariable adjustment. CONCLUSIONS: MAs scored worse than non-Hispanic whites on all outcomes after adjustment for confounding factors; differences were only partially explained by ethnic differences in survival. These findings in combination with the increased stroke risk in MAs suggest that the public health burden of stroke in this growing population is substantial.

Neurocognitive functioning in antiretroviral therapy-naïve youth with behaviorally acquired human immunodeficiency virus.

PURPOSE: Youth living with human immunodeficiency virus (HIV) account for over one third of new HIV infections and are at high risk of adverse psychosocial, everyday living, and health outcomes. Human immunodeficiency virus-associated neurocognitive disorders (HAND) are known to affect health outcomes of HIV-infected adults even in the era of combination antiretroviral therapy. Thus, the current study aimed to characterize the prevalence and clinical correlates of HAND in youth living with HIV. Here, we report baseline neurocognitive data for behaviorally HIV-infected youth enrolled in a prospective study evaluating strategies of antiretroviral treatment initiation and use. METHODS: A total of 220 participants, age 18-24 years, who were naive to treatment (except for prevention of mother-to-child HIV transmission; n = 3), completed a comprehensive neurocognitive, substance use, and behavioral health assessment battery. RESULTS: Sixty-seven percent of youth met criteria for HAND (96.4% were asymptomatic and 3.5% were syndromic); deficits in episodic memory and fine-motor skills emerged as the most commonly affected ability areas. Multivariable models showed that lower CD4 count, longer time since HIV diagnosis, and high-risk alcohol use were uniquely associated with neurocognitive deficits. CONCLUSIONS: Over two thirds of youth with behaviorally acquired HIV evidence neurocognitive deficits, which have modest associations with more advanced HIV disease as well as other factors. Research is needed to determine the impact of such neuropsychiatric morbidity on mental health and HIV disease treatment outcomes (e.g., nonadherence) and transition to independent living responsibilities in HIV-infected youth, as well as its long-term trajectory and possible responsiveness to cognitive rehabilitation and pharmacotherapy.

Cardiovascular risk score, cognitive decline, and dementia in older Mexican Americans: the role of sex and education.

BACKGROUND: The purpose of this study was to examine the associations of cardiovascular disease (CVD) risk with cognitive decline and incidence of dementia and cognitive impairment but not dementia (CIND) and the role of education as a modifier of these effects. METHODS AND RESULTS: One thousand one hundred sixteen Mexican American elderly were followed annually in the Sacramento Area Latino Study on Aging. Our sex-specific 10-year CVD risk score included baseline age, systolic blood pressure, total cholesterol, high-density lipoprotein, smoking, body mass index, and diabetes. From adjusted linear mixed models, errors on the Modified Mini-Mental State Exam (3MSE) were annually 0.41% lower for women at the 25th percentile of CVD risk, 0.11% higher at the 50th percentile, and 0.83% higher at the 75th percentile (P value of CVDrisk×time <0.01). In men, 3MSE errors were annually 1.76% lower at the 25th percentile of CVD risk, 0.96% lower at the 50th percentile, and 0.12% higher at the 75th percentile (P value of CVDrisk×time <0.01). From adjusted linear mixed models, the annual decrease in the Spanish and English Verbal Learning Test score was 0.09 points for women at the 25th percentile of CVD risk, 0.10 points at the 50th percentile, and 0.12 points at the 75th percentile (P value of CVDrisk×time=0.02). From adjusted Cox models in women, compared with having <6 years of education, having 12+ years of education was associated with a 76% lower hazard of dementia/CIND (95% CI, 0.08 to 0.71) at the 25th percentile of CVD risk and with a 45% lower hazard (95% CI, 0.28 to 1.07) at the 75th percentile (P value of CVDrisk×education=0.05). CONCLUSIONS: CVD risk score may provide a useful tool for identifying individuals at risk for cognitive decline and dementia.

Effect of ethnicity and race on cognitive and language testing at age 18-22 months in extremely preterm infants.

OBJECTIVE: To evaluate the relationship of race/ethnicity to Cognitive and Language scores on the Bayley Scales of Infant and Toddler Development, Third Edition in extremely preterm toddlers (<28 + 0 weeks' estimated gestational age). STUDY DESIGN: This cohort study included extremely preterm toddlers seen at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers evaluated at 18-22 months adjusted age from 3 race/ethnic groups (white, black, and Hispanic white). Multivariate regression modeling was used to identify race/ethnic differences, after adjusting for medical and psychosocial factors. RESULTS: The study population comprised 369 whites, 352 blacks, and 144 Hispanic whites. Cognitive scores differed among the 3 groups on unadjusted analysis (P ≤ .001), but not after adjusting for medical and psychosocial factors (P = .13). Language scores differed on adjusted and unadjusted analyses. Whites scored higher than blacks and Hispanic whites, and blacks scored higher than Hispanic whites. CONCLUSIONS: A combination of medical variables and primary caretaker education accounted for differences in Bayley Scales of Infant and Toddler Development, Third Edition Cognitive scores among the 3 groups. Black and Hispanic white toddlers had lower Language scores than whites, even after adjustment. Early intervention should be targeted to these identified risk factors. Assessment of early language development in minority children may be warranted.

Sleep quality and sleep problems in Mexican Americans aged 75 and older.

BACKGROUND AND AIMS: Sleep complaints and poor sleep quality are common in the elderly population. The aim of this study was to determine factors associated with sleep complaints and poor sleep quality among older Mexican Americans over a 3-year period. METHODS: One thousand eighty-five non-institutionalized Mexican American aged 75 years and older. Sociodemographic characteristics, medical conditions, depressive symptoms, disability cognitive impairment, body mass index, sleep problems (trouble falling asleep, waking up several times per night, trouble staying asleep and awaking not rested) and overall sleep quality were obtained. RESULTS: Of 1085 participants, 12.6% reported trouble falling asleep, 30% waking up several times per night, 11.4 % trouble staying asleep, 9.4% awaking not rested and 16.6% poor sleep quality. Depressive symptoms and heart attack predicted trouble falling asleep; diabetes, cancer and obesity predicted waking up several times per night; diabetes, hypertension, cancer and depressive symptoms predicted both trouble staying asleep and awaking not rested. Being female, married, heart attack and depressive symptoms were associated with poor quality sleep. CONCLUSIONS: Different risk factors were associated with different aspects of sleep complaints. Since poor sleep has been linked to poor outcomes, a good understanding of these factors may help in designing interventions to improve sleep quality in this population.

Assessing neuropsychological performance in a migrant farm working Colonia in Baja California, Mexico: a feasibility study.

Neuropsychological impairments (NPI) can lead to difficulties in daily functioning and ultimately contribute to poor health outcomes. However, evidence for the feasibility of NPI assessment in resource-limited settings using tests developed in high literacy/high education cultures is sparse. The main objectives were to: (1) determine the feasibility and appropriateness of conducting neuropsychological assessments among a migrant farm worker population in Baja California, Mexico and (2) preliminary describe neuropsychological test performance in this unique population. A neuropsychological test battery was administered to 21 presumably healthy adults (8 men, 13 women) during a two-day international health services and research collaboration. All but one neuropsychological test (i.e. figure learning) was feasible and appropriate to administer to the study population. Contrary to expectations, participants performed better on verbal rather than nonverbal neuropsychological tests. Results support inclusion of neuropsychological tests into future studies among migrant farm worker populations in Baja California, Mexico.