Measuring the Impact of Structural Gendered Racism on Black Women’s Cognitive Aging and Risk of Alzheimer’s Disease and Related Dementia: A Mixed-Methods Investigation

PROJECT ABSTRACT Disparities in Alzheimer’s disease and related dementias (ADRD) exist across race as well as sex/gender, and structural oppression is hypothesized to be an important social determinant. Mounting evidence demonstrates that exposure to structural racism in early- and mid-life is associated with lower memory and neurocognitive

performance in late life. To remediate the harms of structural racism, it is essential to understand how racism intersects with other systems of oppression, like structural sexism, to affect the cognitive aging of those with multiple marginalized identities (e.g., being both Black and a woman). Cognitive aging is strongly impacted by

the social environment across the lifecourse and may be accelerated by early life exposures to cross-cutting racism and sexism. Among aging Black women, exposure to intersecting structural racism and sexism (i.e., structural gendered racism) across the life course may compound to accelerate cognitive decline and increase

ADRD risk. This hypothesis has not been tested due to measurement limitations as well as reliance on between- group comparative study designs, which limit our understanding of the mechanistic processes that impact vulnerable populations and confer dementia risk. In response to this need, the scientific goal of this study is to

use a mixed-methodological, within-group approach to: (1) develop and validate a multidimensional index of structural gendered racism using qualitative interviews with Black women, (2) identify categorically distinct latent class profiles of structural gendered racism across index dimensions, and (3) examine the associations between

latent class profiles of early life exposure to structural gendered racism with cognitive aging and ADRD risk. To achieve these aims, 68 Black women aged 50 or older across the United States will participate in qualitative interviews of their experiences of gendered racism to further explicate structural domains of influence (e.g.,

gendered racism impacting access to housing). The PI will then conduct focus group interviews with research and data experts to determine metrics that capture each gendered racism domain and identify corresponding datasets that will be leveraged to create a state-level gendered racism index. This index will be linked to

geographically coded data on early childhood from 4,793 Black women in the Health and Retirement Study (HRS) and their cognitive data collected over 24-years in late adulthood. These new data will be analyzed for gendered racism latent classes, and the latent classes will be examined in relation to cognitive aging trajectories

and ADRD risk. Consistent with NIA’s Strategic Directions for Research, this study may illuminate mechanisms underlying Black women’s risk for ADRD and identify critical intervention points that can be addressed to reduce racial-sex/gender disparities in ADRD and improve the cognitive health of Black women. The research plan is

complemented by training activities that build on the candidate’s background in neuropsychology and provide new training in (1) longitudinal and latent variable modeling; (2) intersectional structural determinants of Black women’s cognitive aging; (3) mixed methods research; and (4) clinician-scientist leadership development.