This document summarizes a study examining predictors of cognitive decline among elderly Mexicans in Mexico and Mexican Americans in the United States over a 10-year period. The key findings are: 1) The proportion of elders showing cognitive decline after 10 years was higher among Mexicans in the US (33%) than in Mexico (23%). The rate was higher in women in Mexico and men in the US. 2) Common risk factors for cognitive decline included age, education, diabetes, and functional impairment. Gender played a role in some social and sensory variables. 3) Sensory impairment, lack of health access, and never having worked were also predictors. For Mexican women, not considering religion important and lack of money

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PREDICTING FACTORS OF
COGNITIVE DECLINE
AMONG THE ELDERLY:
THE CASE OF MEXICANS IN
MEXICO AND THE UNITED STATES
SILVIA MEJIA-ARANGO
DEPARTAMENTO DE ESTUDIOS DE POBLACION
EL COLEGIO DE LA FRONTERA NORTE
TIJUANA, MEXICO
ROGELIO SAENZ
COLLEGE OF PUBLIC POLICY
UNIVERSITY OF TEXAS IN SAN ANTONIO

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Introduction
The World report for AD and other dementias
(2015):
46.8 millons of persons with dementia in the
world.
Projected to be 74.7 millions in 2030 and
131.5 millions in 2050
58% of the people with dementia live in low
and middle income countries.

3. +In México (MHAS, 2011):
6% prevalence of global dementia
29% prevalence of cognitive impairment no
dementia (CIND)
Increases with age, decreases with years of
education, and is higher in women
Among the different ethnic groups in the US:
Higher prevalence of dementia and cognitive
impairment among blacks and Hispanics compared
with non-Hispanic whites

4. +
The differences among racial and ethnic
groups are a result of the interaction
between genetic and environmental
factors:
 Risk factors
 Health Behaviors
 Depression
 Networks
 Access to health services

5. +
Objectives
General:
The purpose of the present study was to
examine cognitive decline ands its correlates
among Mexicans and Mexican Americans
Specific:
 To measure changes in cognitive function in
the elderly over a 10-year period.
 To identify predictors of cognitive decline.
 To compare the effects of the predictor
variables between Mexican-Americans and
Mexicans

6. PREDICTOR VARIABLES
1. SOCIODEMOGRAPHICS AND
EDUCATIONAL ATTAINMENT
Age, sex, education,
2 MIGRATION Migrated, age of migration, years in the US
3 FAMILY AND SOCIAL NETWORKS Married, see children, count on friends/relatives, have
someone to talk to
4 PSYCHOLOGICAL FACTORS Depressive symptoms, locus of control for health,
importance of religion, volunteer or participate in non
religious activities
5 OCCUPATION Employed at T1, Ever Employed, Principal Occupations,,
money for medical care
6 ACCESS TO HEALTH Health insurance, Money problems for medical care
7 HEALTH BEHAVIORS Smoking, drinking
8 FUNCTIONALITY Need help in 1> ADLs or 2> IADLs
9 SENSORY LIMITATIONS Vision and hearing problems
10 MEDICAL CONDITIONS Hypertension, diabetes, heart attack
11 FUNCTIONALITY Need help in 1> ADLs, Need help in 2> IADLs

7. +
Subjects
 65 and older
 Mexican-Americans from the Hispanic Established
Populations for Epidemiologic Studies of the Elderly
 Wave 1 (1994-1995) and Wave 5 (2004-2005)
 Mexicans from the Mexican Health and Aging Study
(MHAS)
 Wave 1 (2001) and Wave 3 (2012)
 With Normal cognition at Wave 1
 Cognitive function was assessed using the MMSE in the HEPESE
and the CCCE in the MHAS
 HEPESE: Based on age and educational level, subjects with
scores above the 1st quartile were classified as normal
 MHAS: Based on the CCCE norms for age and education

8. FLOW CHART OF SAMPLE SELECTION
Fig 1 Hispanic EPESE
1993-1994
3,050
With
cognitive
assessment
n=2,852
Without
cognitive
assessment
n=198
Normal
Cognition
n=2,089
Follow-up
2004-2006
n=902
Impaired
Cognition
n=763
Died= 818
Lost = 344
Refuse =25
Fig 2 MHAS STUDY
2001
4,872
With
cognitive
assessment
n=4,634
Without
cognitive
assessment
n=238
Normal
Cognition
n=3,775
Follow-up
2004-2006
n=1869
Impaired
Cognition
n=763
Died= 1,409
Lost = 442
Refuse =55

9. Selectivity of the followed-up
DIED
> Men
> Age
< Educated
>Migrated
LOST
>Women
>Age
>Educated
>Migrated

10. +
COGNITIVE
STATUS AFTER 10
YEARS
MHAS
Cognitive Normal: 76.7%
Cognitive Impaired: 23.3%
HISPANIC EPESE
Cognitive Normal: 66.7%
Cognitive Impaired: 33.3%

11. +
COGNITIVE
IMPAIRMENT
AFTER 10 YEARS
MHAS
MEN: 21.2%
WOMEN: 24.9%
HISPANIC EPESE
MEN: 37.4%
WOMEN: 31.0%

12. Predictor variables
MHAS HEPESE
Normal
Cognitively
Impaired
Cognitively
P
Value
Normal
Cognitively
Impaired
Cognitively
P
Value
SOCIO-DEMOGRAPHICS
Sex (F) 54.8 60 * 34.2 40.8 *
Age 70.2 (4.5) 71.6 (5.7) ** 70.8 (4.6) 71 (4.9) NS
65 to 64 yrs. (%)
70 to 74 yrs. (%)
75 to 79 yrs. (%)
80 and more (%)
51.9
31.6
12
4.6
42.1
28.7
19.2
10
** 48.1
31.1
15.8
5
46.6
33.3
10.7
9.2
*
Education 3.4 (3.6) 2.9 (3.5) * 5.6 (3.9) 4.7 (3.5) **
Illiteracy (%) 30.5 37.9 ** 12 19.1 **
MIGRATION
US Migrants 11.8 10.3 NS 43.3 41.2 NS
Age of Migration 27 (10.7) 30.2 (15.9) NS 32.2 (16.7) 30.5 (17.9) NS
• <18 yrs. old 82.1 83.3 NS 79.8 70.8 *
• 18 yrs. ormore 17.9 16.7 20.2 29.2
Years lived in the US 5.5 (8.1) 8.6 (11.9) * 38.9 (18.1) 40.9 (18.9) NS
• <10 yrs. 6 17.9 * 91.3 89.6 NS
• 10 yrs. ormore 94 82.1 8.7 10.4
FAMILY AND SOCIALNETWORKS
Married (%) 62.3 52.3 ** 63.5 61.5 NS
Have children (%) 96 95.5 NS 92.1 93.5 NS
Numberof children 6.1 (3.2) 6.1 (3.3) NS 4.8 (3.2) 4.9 (3.1) NS
See children 46 51 * 95.8 95.1 NS
Count on friends/ relatives 63.2 64.3 NS 90.6 89.9 NS
Have someone to talk 82.5 80.2 NS 89.1 89.1 NS
PSYCHOLOGICALFACTORS NS
Depressive symptoms 2.9 3.07 NS 0.98 1.14 NS
Internal Locus of control for
health
92.8 90.3 NS 94.3 92.6 NS
Importance of Religion (high) 97.5 96.2 NS 73.3 66 *
Participate in non-religious
activities
12.9 14.0 NS 11.7 8.8 NS

13. MHAS HEPESE
Normal
Cognitively
Impaired
Cognitively
P
Value
Normal
Cognitively
Impaired
Cognitively
P
Value
OCCUPATION HISTORY
Employed now 45.4 38.7 * 16.4 17.9 NS
Ever Worked 77.7 74.9 NS 96.8 92.4 *
Principal Occupation
• Managerial and
Technical
25.2 22.8 NS 17.8 14.4 NS
• Precision production
and repairment
20.6 20.5 10.7 12.3
• Service Occupations 19 17.9 24 23
• Operators, laborers
and transportation
10.5 9.9 24.5 27.3
• Farming, forestry and
fishing
24.6 28.8 23 23
HEALTH
Quality of Health
• Poor - Fair 65.5 69.8 NS 47.2 43.7 NS
No Health coverage 36.3 38.6 NS 94.5 92.4 NS
Money problems for
medical care
48.1 22.7 * 33.1 40.9 *
Diabetes 10.7 14 * 18.6 26.8 *
Hypertension 41.1 41.2 NS 41 43.5 NS
Heart attack 3.1 3.9 NS 6.9 8.8 NS
Cerebral-Vascular
disease
1.0 2.9 ** 2.7 3.4 NS
SENSORY LIMITATIONS
Vision Problems 9 14.7 ** 19.8 26.7 *
Hearing Problems 5.5 8.6 * 3.6 8.0 **
HEALTH BEHAVIORS
Smoke 28.8 32 NS 26.6 29.9 NS
Drink 27.0 22.6 * 21.4 20.3 NS
FUNCTIONALITY
Need help in 1> ADLs 6.1 8.7 * 1.0 3.4 *
Need help in 2> IADLs 1.6 5.0 ** 1.3 5.7 **
Need help in both 3.0 6.7 ** 0.2 1.5 *
Predictor variables (cont.)

14. Odds of Cognitive Impairment
MHAS HEPESE
Age 2.58** 1.85*
Education 0.98* 0.94*
Age of Migration (<18 yrs) - 3.25**
Not Married 1.54** -
Employed 1.37* -
Never Worked - 2.59**
No Health service 2.78* -
Money problems for medical care - 1.39*
Diabetes 1.78** 1.56**
CVD 2.92** -
Vision Limitations 1.65** 1.47*
Hearing Limitations - 2.33*
Functional impairment IADLs 2.75** 4.4**

15. Odds Cognitive Impairment by Sex
MEN WOMEN
0.1 1
Need Help in 2> IADLs
Hearing Problems
Vision Problems
Cerebro Vascular Disease
Diabetes
Money problem for medical care
No health insurance
Not employed
Never worked
Religion not important
External Locus of Control
Not Married
Age of Migra on (<18 yrs old)
Educa on
Age 80>
Age 75-79
HEPESE MHAS
1 10
Need Help in 2> IADLs
Hearing Problems
Vision Problems
Cerebro Vascular Disease
Diabetes
Money problem for medical care
No health insurance
Not Employed
Never worked
Religion not important
External Locus of Control
Not Married
Age of Migra on (<18 yrs old)
Educa on
Age 80>
Age 75-79
HEPESE MHAS

16. RESULTS: PREDICTOR VARIABLES
1. SOCIODEMOGRAPHICS AND
EDUCATIONAL ATTAINMENT
MHAS
HEPESE
Age effect (men and women)
Age effect (men)
Education (women)
2 MIGRATION HEPESE Age of migration <18 yrs (men)
3 FAMILY AND SOCIAL NETWORKS MHAS Not married (men)
4 PSYCHOLOGICAL FACTORS MHAS External locus of control (men)
Religion not important (women)
5 OCCUPATION HEPESE Never worked (men)
6 ACCESS TO HEALTH MHAS
HEPESE
No health service (women)
No money for health care (women)
7 HEALTH BEHAVIORS
9 SENSORY LIMITATIONS MHAS
HEPESE
Vision and Hearing limitations
(women)
10 HEALTH CONDITIONS MHAS
HEPESE
Diabetes (women) CVD (men)
Diabetes (women)
11 FUNCTIONALITY HEPESE IADLs (women)

17. +
Conclusions
The proportion of elders that showed cognitive
decline after a 10-year period is higher among
Mexicans in the US (33%) than among Mexicans in
Mexico (23%).
The rate is higher in women among the Mexicans
living in Mexico and its higher in men among
Mexican-Americans.
This result is in agreement with other studies that
show a health disadvantages in the migrant
community due to negative acculturation.

18. +
Conclusions
A common pattern of risk factors
between groups on the
"strong”variables
Different pattern related to social
variables
Gender effect in strong and
social variables

19. +
Conclusions
Educational attainment has been
frequently reported as a risk factor for
cognitive impairment and dementia. The
functional and brain reserve hypothesis has
been used to explain how low educated
individuals have a less well prepared brain
to face aging. Mexican American women had
the higher education level (5.75 years)
Sensory impairment has also been shown
to have an effect in reducing the
opportunities that individuals have of
adequate cognitive stimulation.

20. +
Conclusions
Diabetes: is also a very important predictor of
cognitive impairment.We have published some
results before showing that it increases the risk of
dementia 2 times compared with non-diabetic
individuals.
 Diabetes can cause microvascular disease and an
increase in insulin resistance affecting brain
function
Occupation Status: (Never worked) lack of
cognitive stimulation, social engagement, health
issues?
No Health Access: Risk factor for cognitive
impairment

21. +
Conclusions (cont.)
 Not being married was a predictor of cognitive
decline only among Mexican men.
Several studies have reported a protective effect of
being married on the risk of dementia.
 For Mexican-americans, the community context
which also others called the barrio effect
protects for cognitive decline regardless of
marital status.

22. +
Conclusions (cont.)
The Importance of religion/Attendance at mass, for
cognitive decline has been mentioned on a paper
by Hill and colleagues who discuss their results in
terms of the social engagement it implies.
In our study this was only true for Mexican women,
however only 1.4% of the women did not considered
religion as important and most of these women were
cogntively impaired

23. +
Conclusions (cont.)
The result of functional impairment as a predictor
variable for cognitive decline is a very important
result due to the timing it shows.
Needing help to carry out the instrumental activities
of daily living is happening before cognitive
impairment in Mexican-American women.
Negative Acculturation?

24. +
Final
Cognitive decline is not
ONLY explained by strong
variables as age, health
conditions and health
access.
Migration variables as well
as social and psychological
variables had an effect on
cognitive decline.
There is gender effect on
“strong”and non-strong
variables”
A Negative acculturation
explanation?
Conclusions

25. +
THANK YOU
smejia@colef. mx