Sociocultural determinants of sleep, cognitive decline, and dementia among an intergenerational Latino cohort in the Sacramento, California region

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  • March 21, 2019
Creator
  • Miller, Erline
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Latinos in the US face higher proportions of dementia. Understanding how acculturation relates to cognition may provide insight to the mechanistic pathways driving this disparity. High US acculturation, when compared to an orientation towards another birth/ancestral country, has been linked to some poor health outcomes and may negatively shape cognition through these pathways. Poor sleep is an important risk factor that has been largely unexplored among Latinos, though evidence suggests a disproportionate burden. We addressed three gaps in our understanding of the Latino cognitive disparity within an intergenerational Sacramento, California cohort: (1) sociocultural mechanisms and sleep; (2) sociocultural mechanisms, cognitive decline, and dementia; and (3) sleep, cognitive decline, and dementia, with ApoE-ε4 genotype. Sacramento Area Latino Study on Aging comprised older age generation 1 (GEN1) and Niños Lifestyle & Diabetes Study comprised middle-age generation 2 (GEN2). US acculturation may pattern sleep differentially by acculturative status of previous generations, socioeconomic context, and potentially age. High intergenerational US acculturation was associated with worse sleep among GEN2, but better sleep among GEN1. However, the beneficial association among GEN1 may be a function of lower SEP. Cognitive outcomes were explored among GEN1. High US acculturation was associated with better cognitive performance and reduced dementia/cognitive impairment, not dementia (CIND) risk. Fatigue was also associated with worse cognitive performance, but sleep, cognitive decline, or incident dementia/CIND were not associated in this population. However, sleep-cognition associations need to be assessed bi-directionally and in larger populations to gain a full understanding. High US acculturation may improve sleep and cognitive outcomes in low socioeconomic settings and acculturation across generations may differentially shape health, though a greater understanding of the underlying sociodemographic mechanisms is needed. If replicated, sociocultural pathways should be considered in sleep and cognitive research among Latinos. Pending further exploration of sleep and cognition, better sleep may link high US acculturation and improved cognitive outcomes. Future studies can build upon these findings as knowledge of broad sociocultural determinants can guide identification of modifiable intervention targets (e.g. sleep). Knowledge of a sociocultural framework can also guide the development of prevention and intervention efforts (e.g. community integration component).
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  • In Copyright
Advisor
  • Robinson, Whitney
  • Prather, Aric
  • Yang, Yang
  • Aiello, Allison
  • Avery, Christy
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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