The age at which school racial desegregation occurred was associated with differences in late-life cognition among older Black adults, data from the Study of Healthy Aging in African Americans (STAR) cohort showed.
Older Black Americans who transitioned to integrated schools in their early years of education had significantly better executive function and semantic memory than those who attended only segregated schools, reported Rachel Peterson, PhD, MPH, MA, of the University of California, Davis, and co-authors in JAMA Network Open.
Compared with older Black adults who attended only segregated schools, those who attended integrated schools at some point between grades 1-12 had :
- Better executive function if they transitioned to integrated schools between grades 1 and 5 (β=0.35, 95% CI 0.08-0.61, P=0.01)
- Better semantic memory performance if they attended only integrated schools (β=0.34, 95% CI 0.14-0.54, P=0.001), or if they transitioned to integrated schools between grades 1 and 5 (β=0.43, 95% CI 0.15-0.72, P=0.003)
- No significant difference in verbal episodic memory scores if they transitioned to integrated schools between grades 1 and 5 (β=0.07; 95% CI, −0.22 to 0.35; P=0.66).
“These results suggest that racially segregated schooling experiences, including de facto segregation present today, may be associated with worse late-life cognition,” Peterson and colleagues wrote.
The lack of findings for verbal memory “may be because semantic memory and executive function may be more greatly associated with education and early life experiences, whereas verbal episodic memory is not,” they noted.
The team analyzed data from 699 self-identified Black older adults who were dementia-free at baseline with an average age of 68.5; 69.2% were women. Data came from the STAR cohort, a study of late-life cognition among African Americans in Northern California who were members of the Kaiser Permanente health system, and were collected from 2018 through 2019.
Participants reported whether they attended a segregated school in grades 1, 6, 9, and 12 and were grouped into one of the following categories: attended only integrated schools (n=435), began attending integrated schools between grades 1 through 5 (n=50), began attending between grades 6 through 8 (n=48), began attending between grades 9 through 12 (n=29), ever moved from integrated to segregated school (n=26), and never attended an integrated school (n=111).
Cognitive measures of executive function, semantic memory, and verbal memory were obtained with the Spanish and English Neuropsychological Assessment Battery and related to integrated schooling history. People who never attended an integrated school were used as a reference group.
Black adults who had attended only integrated schools had significantly better semantic memory, but no statistically significant differences in executive function or verbal memory compared with their counterparts who had never attended integrated schools.
No significant difference for any cognitive domain was seen for participants who transitioned from segregated to integrated schools between 6th and 8th grades or between 9th and 12th grades versus participants who never attended integrated schools. No significant differences were found when testing for potential interactions by sex, Southern birth, or baseline age.
“Peterson et al reported associations of unusually large magnitude,” observed Paris Adkins-Jackson, PhD, MPH, of Massachusetts General Hospital in Boston, and Jennifer Weuve, MPH, ScD, of Boston University, in an accompanying editorial, noting that the cognitive differences in the study compared with changes seen from 6-8 years of aging in the Chicago Health and Aging Project cognitive test scores.
“Attention should be paid to differences of such magnitude,” Adkins-Jackson and Weuve wrote. “Estimating the overall effect of integrated schooling on adult cognition requires a deeper discussion of confounding, mediating, and moderating factors—housing, banking, health care, parental occupation, the legal system, and racism-motivated violence and terrorism.”
“This study sparks a need for a discussion on how, or whether, to distinguish the sequelae of integrated schooling from the determinants of it, particularly those that could themselves affect adult cognition independently from attending integrated schools,” the editorialists added.
Prior research includes mixed evidence about the effect of integrated schooling on later-life cognition in Black Americans. A 2014 study found “a slight advantage of desegregated schooling for cognitive performance, but no advantage of desegregated schooling on the rate of cognitive change over time,” in 420 Baltimore residents. Yet, attending a desegregated school was associated with worse baseline cognition among 498 participants in a 2019 report.
The discrepancies in these studies “may be due to differences in the cohorts, such as age or where the participants attended school (i.e., the South vs Northeast or Midwest),” Peterson and co-authors noted. “The experiences of older participants who attended a de jure segregated school in the South likely differ from those of younger participants who attended a de facto segregated school in the Midwest in ways that may be associated with late-life cognition.”
A limitation of the study was that it lacked early life cognitive data. The cohort was subject to selection and survival biases, and people with dementia were excluded. Unmeasured confounders may have influenced results, the researchers noted.
“Even if de jure segregation is in the past, understanding its effects on adult cognition is part of a larger social obligation of being accountable to the costs of racism and may itself open up pathways to intervening after the fact,” Adkins-Jackson and Weuve noted. “With de facto school segregation still very much present, understanding its effects on adult cognition could inform interventions that affect the future cognitive health of millions of children.”
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Older Black Americans who transitioned to integrated schools in their early years of education had significantly better executive function and semantic memory than those who attended only segregated schools.
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With de facto school segregation still present, understanding its effects on adult cognition may inform interventions that affect the future cognitive health of millions of children, the editorialists noted.
Paul Smyth, MD, Contributing Writer, BreakingMED™
The STAR cohort is funded by the NIH/NIA.
Peterson is supported by the NIH/NIA Neuroscience of Cognitive Aging Training grant.
Weuve reported receiving personal fees from Alzheimer’s Association outside the submitted work.
Cat ID: 130
Topic ID: 82,130,585,730,130,192,255,151,925
