{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:11:23Z","timestamp":1791893483366,"version":"4.3.4"},"reference-count":59,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:sec id=\"ab-noi200014-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi200014-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether cumulative BP levels explain racial differences in cognitive decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi200014-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>\n                      Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as\n                      <jats:italic>t<\/jats:italic>\n                      scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi200014-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi200014-8\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Race (black vs white).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi200014-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 34\u202f349 participants, 19\u202f378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19\u202f378 individuals, 10\u202f724 (55.3%) were female and 15\u202f526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (\u22120.03 points per year faster [95% CI, \u22120.05 to \u22120.01];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.004) and memory (\u22120.08 points per year faster [95% CI, \u22120.11 to \u22120.06];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (\u22120.018 points per year faster per each 10\u2013mm Hg increase [95% CI, \u22120.023 to \u22120.014];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), memory (\u22120.028 points per year faster per each 10\u2013mm Hg increase [95% CI, \u22120.035 to \u22120.021];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), and executive function (\u22120.01 points per year faster per each 10\u2013mm Hg increase [95% CI, \u22120.014 to \u22120.007];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (\u22120.01 points per year [95% CI, \u22120.03 to 0.01];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.56) and memory (\u22120.06 points per year [95% CI, \u22120.08 to \u22120.03];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) but not executive function (0.10 points per year [95% CI, 0.09-0.11];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi200014-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>These results suggest that black individuals\u2019 higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2020.0568","type":"journal-article","created":{"date-parts":[[2020,4,13]],"date-time":"2020-04-13T11:36:22Z","timestamp":1586777782000},"page":"810","source":"Crossref","is-referenced-by-count":107,"title":["Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals"],"prefix":"10.1001","volume":"77","author":[{"given":"Deborah A.","family":"Levine","sequence":"first","affiliation":[{"name":"Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor"},{"name":"Stroke Program, Department of Neurology, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alden L.","family":"Gross","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, John Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Brice\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Tilton","sequence":"additional","affiliation":[{"name":"Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed U.","family":"Kabeto","sequence":"additional","affiliation":[{"name":"Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie M.","family":"Hingtgen","sequence":"additional","affiliation":[{"name":"Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno J.","family":"Giordani","sequence":"additional","affiliation":[{"name":"Michigan Alzheimer\u2019s Disease Center, Department of Psychiatry, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy B.","family":"Sussman","sequence":"additional","affiliation":[{"name":"Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"VA Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney A.","family":"Hayward","sequence":"additional","affiliation":[{"name":"Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"VA Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Stroke Program, Department of Neurology, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"VA Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell S. 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