Understanding Mild Cognitive Impairment Among African-Americans Patients: A Social Work Role

Background: Rates of mild cognitive impairment (MCI) are higher in African-Americans than White U.S. populations. These ethnoracial variations may be attributed to variations in lifestyle, health, and socioeconomic risk factors. Risk factors that simultaneously increase the risk of neurodegeneration include health conditions such as diabetes, depression, cardiovascular disease, and socioeconomic factors, such as lower education levels. These factors are also more prevalent among African-Americans. This paper presents findings from an investigation designed to identify additional biological factors which may predict MCI development among an African-American population of adults presenting at United States Alzheimer’s Disease Centers.  

Methods: Utilizing an ecological framework to guide the study, generalized estimating equation modeling was used to examine repeated measures in an analytic sample of 9,872 African-American men (n=2,440) and women (n=7,432). The average age of the sample was 74 years (SD: 8.76). Logistic regression estimated odds ratios for traumatic brain injury (TBI), thyroid, diabetes, hypertension, and cardiovascular conditions predicting MCI (amnestic and nonamnestic combined) in the National Alzheimer’s Coordinating Center, Uniform Data Set. Variables with p<.05, were used to build a multivariable logistic model to identify independent predictors of MCI. All subsequent analyses were adjusted for age, sex, education, and marital status.

Results: Education achievement at or below a high school degree was associated with MCI development (p<.001). Male sex was also associated with development of MCI. African-Americans with TBI were 1.7 times more likely to develop MCI compared to those with no reports of a TBI. Both active and inactive thyroid conditions decreased risk of MCI development. Compared to those without a thyroid condition, those with an active thyroid condition were 54% less likely to develop MCI, and those with an inactive/remote thyroid status were 75% less likely to develop MCI, when adjusting for age, education, and marital status.

Conclusions and Implications:  Since African Americans have the highest rate of death from TBI, findings support that for those reporting a TBI, the risk of MCI development was elevated. Social workers are well-positioned to potentially help decrease the development of MCI by helping patients reduce risk factors for TBI. Social workers in health care settings can play in important role to assist patients to understand the symptoms of TBI, as part of a comprehensive evaluation. There are mixed findings regarding hypothyroidism and the African American population. Hypothyroidism is associated with an increased risk of death in African-Americans. Surprisingly, findings from this investigation did not suggest that hypothyroidism increased the likelihood of MCI. Findings indicate that hypothyroidism decreased the risk of MCI. Empirical research suggests that African-American racial heritage may be protective against hypothyroidism development. Despite the results, it is critical that social workers in health care settings working with patients experiencing cognitive and emotional disturbances consider referring patients to be evaluated for a thyroid condition. This investigation provides formative data to further explore the role of health conditions that specifically affect African Americans and the development of MCI and to test empirically based interventions to potentially reduce the development of MCI.