title: Diabetes and cognitive decline: investigating the potential influence of factors related to health disparities.
abstract: OBJECTIVE
  The authors investigated whether factors related to health disparities--race, rural residence, education, perceived racial discrimination, vascular disease, and health care access and utilization--may moderate the association between diabetes and cognitive decline.
  
  
  METHODS
  Participants were 624 community-dwelling older adults (49% African American and 49% rural) who completed in-home mini-mental state examination at baseline and 4-year follow-up.
  
  
  RESULTS
  Diabetes at baseline predicted four-year cognitive decline in regression models adjusted for a number of possible confounds. Only perceived discrimination and health utilization showed significant interaction effects with diabetes. Among African Americans who reported experiencing racial discrimination, there was a stronger relationship between diabetes and cognitive decline. Among participants who reported absence of visiting a physician within the past 6 months, the association between diabetes and cognitive decline was substantially larger.
  
  
  CONCLUSIONS
  Findings suggest that factors related to health disparities may influence cognitive outcomes among older adults with diabetes.
authors.affiliation: Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294-2100, USA. mgcrowe@uab.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Crowe
authors.forename: Andrea
authors.initials: A
authors.lastname: Sartori
authors.forename: Olivio J
authors.initials: OJ
authors.lastname: Clay
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Wadley
authors.forename: Ross
authors.initials: R
authors.lastname: Andel
authors.forename: Hui-Xin
authors.initials: HX
authors.lastname: Wang
authors.forename: Patricia
authors.initials: P
authors.lastname: Sawyer
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D016001:Confidence Intervals; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000473:pathology*; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D016017:Odds Ratio; D011594:Psychometrics; D012307:Risk Factors; D057566:Self Report; D014481:United States