Stress internalization associated with cognitive decline among older U.S. Chinese

INTRODUCTION Behavioral and sociocultural factors in minority populations in the U.S. are commonly examined as independent contributors or buffers to health disparities in cognitive decline, but can demonstrate significant inter-relatedness due to broader contextual factors (e.g., acculturation). Analyzing influence of correlated behavioral and sociocultural traits can better identify targets for future intervention. The current study aimed to account for interdependent risk and resilience factors associated with cognitive decline in non-demented older U.S.-dwelling Chinese adults. METHODS The sample consisted of 1,528 older U.S. Chinese (60 and older) with normal cognition and function at baseline who attended three waves of the Population Study of ChINese Elderly (PINE). We used principal component analysis to generate memory and executive functioning outcomes; factor analysis to reduce behavioral and sociocultural variables into latent constructs; and linear mixed-effects models to evaluate the impact of these constructs, as well as of demographic and medical factors (e.g., cardiovascular disease), on longitudinal rates of cognitive decline. RESULTS Factor analysis identified three main behavioral/sociocultural constructs: stress internalization, neighborhood/community cohesion, and external social support. Among these, only stress internalization – consisting of greater perceived stress, greater hopelessness, and lower conscientiousness – was associated with longitudinal decline in memory, while none with decline in executive functioning. Neither acculturation nor social engagement was related to decline in memory or executive function, even though participants with greater acculturation or social engagement had better baseline cognitive performance. DISCUSSION Using a psychometrically and statistically robust model, we found that only the factor underlying stress processing, hopelessness, and conscientiousness was associated with rates of memory decline in this older non-demented U.S. Chinese cohort. These maladaptive traits have been linked to the Asian model minority stereotype but all the same potentially modifiable. Future studies examining disparate health outcomes must account for inter-relatedness among behavioral and sociocultural factors to identify root causes. ### Competing Interest Statement WTH has patents on CSF-based diagnosis of FTLD-TDP and prognosis of MCI-AD and SMA, licensed COVID-19 serology tests to SigmaMillipore, and consulted for Apellis, Biogen, and Fujirebio. ### Funding Statement Rutgers University Asian Resource Center for Minority Aging Research (RCMAR P30 AG059304) Rutgers University Resource Center for Alzheimer's and Dementia Research in Asian and Pacific Americans (RCASIA P30 AG083257) Alzheimer's Disease Neuroimaging Initiative (ADNI U19 AG024904) Health Equity Scholar Program National Institute on Aging ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRBs of Rush University and Rutgers University gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at