Racial differences in the recognition of cognitive dysfunction in older persons

We assessed the influence of race and education on informants' reports of cognitive decline in 252 community-residing older persons who were receiving services from senior health agencies. An expert consensus panel made diagnoses of normal cognition, cognitive impairment no dementia (CIND), and dementia based on clinical evaluations and standardized neuropsychological testing (using both population and race-adjusted norms). Informants were interviewed using the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Informants of black participants with CIND reported less cognitive decline (lower IQCODE scores) than informants of white CIND participants [3.03 (0.61) vs. 3.23 (0.41); t (117)=2.12, P ≤ 0.036] even though there were no significant differences in the participants' functional and neuropsychological impairments. An analysis of covariance which controlled for informant education indicated that this difference in IQCODE scores was attributable to the fact that black informants had fewer years of education than white informants. There was no statistically significant difference in IQCODE scores for black and white participants with dementia [4.0 (0.7) vs. 4.3 (0.7); t (67)=1.37, P=0.177]. We conclude that racially determined differences in perceptions of early cognitive decline and education may influence informant ratings of older persons. These differences may contribute to disparities in the detection and treatment of cognitive disorders in older black persons.