Bryce Hong1,2 Kayla Mishima,2,3 Emily Daehler,2,4 Olivia Maehara,2,5 Natalia Gonzalez,1,2 Enrique Carrazana,1 Kore Liow1,2
1 John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI
2 Hawaii Pacific Neuroscience Memory Disorders Center and Alzheimer’s Research Unit, Honolulu, HI
3 University of Hawai’i at Mānoa, Honolulu, HI
4 Northeastern University Boston, MA
5 University of California, Riverside, Riverside, CA
6 University of Puerto Rico, San Juan, PR
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia. Its progression varies widely across individuals, with comorbidities—especially cardiometabolic conditions like diabetes, hypertension, and obesity—suspected to influence the rate of cognitive decline. Native Hawaiians and Pacific Islanders (NHPIs), who experience higher rates of these conditions and earlier dementia diagnoses, remain underrepresented in AD research.
This retrospective study assessed cognitive decline among Asian, White, and NHPI patients using Mini-Mental State Examination (MMSE) scores. Among 623 AD patients with cardiometabolic comorbidities, 105 had both baseline and follow-up cognitive scores (MMSE or Montreal Cognitive Assessment [MoCA]). MoCA scores were converted to MMSE equivalents using a validated conversion method. Annual rates of cognitive decline were calculated and compared between groups using two-tailed t-tests.
The average annual MMSE decline was 0.61 (SD=1.78) for Asians, 0.50 (SD=1.79) for Whites, and 1.45 (SD=2.69) for NHPIs. Although the differences were not statistically significant (Asian vs. White p=0.80; NHPI vs. Asian p=0.19; NHPI vs. White p=0.17), NHPI patients experienced a 2–3 times faster decline in cognitive function compared to the other groups.
Although not statistically significant, the observed trend suggests potentially accelerated cognitive decline in NHPI individuals with AD and cardiometabolic comorbidities. Future studies should include larger sample sizes and control for specific cardiometabolic risk factors to better understand the drivers of these disparities.