COGNITIVE IMPAIRMENTS IN NUYORICANS
Imagine being a constant mental fog; unsure exactly of where or who you are, what time it is or who is talking to you. This exact scenario is a daily way of life for those suffering from cognitive impairments. According to the Centers for Disease Control, cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life (Centers for Disease Control [CDC], 2011). Non-white Hispanics suffer from cognitive impairment at an alarming rate. The rise in cognitive impairments is the result of several factors including the prevalence of certain medical conditions and socioeconomic status.
The term cognitive impairment is classified under several axis I mental alterations. These alterations include delirium, dementia and amnestic disorders (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV-TR], 2000). Many internal and external factors can lead to the development or exacerbation of these mental alterations. Internal factors, such as hypertension, diabetes, neurodegenerative disorders, nutritional, metabolic and endocrine disorders and infectious disorders are all examples of medical conditions that can contribute to cognitive impairment (Round, 2010). External factors include educational background and socioeconomic factors.
Already the largest minority, Hispanics are also the fastest growing ethnic population in the United States (The Americano, 2011). The rise in the population of Hispanics also makes the prevalence of certain conditions, such as cognitive impairment, much more visible. That is especially true in large cities such as New York City. Although the term “Nuyoricans” pertains to those persons of 2nd generation decent from Puerto Rico, I will be taking creative license and applying it to all Hispanics in New York City.
As aforementioned, both internal and external factors play a role in the development of cognitive impairments. At times these internal and external factors can meld together as in the example of diet. Culture has a powerful influence on the diet of Nuyoricans. Many eat foods high in fat or cooked in oil. Because of this and other factors, Nuyoricans are two to three times more likely to have type 2 diabetes mellitus than non-Hispanic whites (Aldrich and Variyam, 2000). Diabetes and the cardiovascular issues that usually accompany it may explain the prevalence of cognitive impairments. As stated by Sasaki et al. “Tthe mechanisms underlying a possible association between diabetes and Alzheimers Diease are unclear, but include the possibility that the production of glycation end products increase Alzheimer's pathology” (1998). According to Manly and Mayeux, a plausible explanation is that the presence of diabetes increases the possibility that an individual will have a stroke or small-vessel disease, both of which increase the risk of AD and dementia diagnosis (2004).
The aforementioned diet can also lead to hypertension which is another major contributor to cognitive impairment. Hypertension is an established risk for stroke. Proceeding a stroke, a person usually shows signs of functional deficits and cognitive impairment. However, preceding a stroke, Waldstein (2003) states:
“hypertension exerts a more subtle impact on the brain that is revealed by diminished cognitive function. Studies comparing the performance of people with high and normal blood pressure levels have shown that high blood pressure or hypertension is related to poorer performance on tests of attention, learning and memory, executive functions, visuospatial skills, psychomotor abilities, and perceptual skills” (p. 1) Works Cited
Waldstein, S. R. (2003, February). The Relation of Hypertension to Cognitive Function. Psychological Science, 12(1), 9-12.
Petersen, R. C., Knopman, D. S., Boeve, B. F., Geda, Y. E., Ivnik, R. J., Smith, G. E., & Roberts, R. O. (2009, December). Mild Cognitive Impairment: Ten Years Later. JAMA, 66(12), 1447-1455.
Silver, K. (2011, October 27). New light being shed on precursor to Alzheimer’s. In WellCommunity. Retrieved April 27, 2013
BRODY, J. E. (2011, September 6). When Lapses Are Not Just Signs of Aging. The New York Times, p. D7.
Anderson, H. S. (2013, January 14). Mild Cognitive Impairment. In Medscape. Retrieved April 28, 2013
National Research Council (US) Panel on Race, Ethnicity, and Health in Later Life; Anderson NB, Bulatao RA, Cohen B, editors. Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. Washington (DC): National Academies Press (US); 2004. 4, Ethnic Differences in Dementia and Alzheimer's Disease.
Lastname, First initial(s) or Organization Name (if given). (Date.) Title of brochure [Brochure]. Place: Publisher. (for CDC)
Luchsinger, J., Mittelman, M., Mejia, M., Silver, S., Lucero, R. J., Ramirez, M., & Kong, J. (2012, September 15). The Northern Manhattan Caregiver Intervention Project: a randomised trial testing the effectiveness of a dementia caregiver intervention in Hispanics in New York City. BMJ Open, 2(5). doi:10.1136/bmjopen-2012