Discrimination and cognitive aging in a cohort of diverse midlife women: The Study of Women's Health Across the Nation

Abstract INTRODUCTION Women may start to experience cognitive aging in midlife, and social determinants have been shown to account for ∼25% of the variation in cognition scores in older age. However, it is not known if discrimination alone or jointly with financial hardship are associated with cognition levels and aging in midlife across multiple cognitive functioning domains. METHODS Using the Study of Women's Health Across the Nation (SWAN), a multi‐racial/ethnic longitudinal study of midlife women, discrimination was measured by the Everyday Discrimination Scale and financial hardship by asking “how hard/diffcult is it to pay for basics?” Cognitive functioning was measured across eight visits. Cognitive processing speed was evaluated via the Symbol Digit Modalities Test (SDMT), working memory using Digit Span Backwards, and verbal episodic memory using delayed East Boston Memory test. Linear mixed‐effects models were used to examine the independent and joint associations of discrimination and financial hardship, with cognition level and change with aging. RESULTS A quarter of women reported “very high” levels of discrimination and/or financial hardship. Very high discrimination was associated with 1.53 lower SDMT (95% confidence interval [CI]: –2.81 to –0.25). Associations were stronger among women with financial hardship (β: –1.40, 95% CI: –2.63 to –0.18) and those who experienced SDMT declines over time (β: –0.21, 95% CI: –0.41 to –0.01). DISCUSSION Results suggest that discrimination is associated with lower cognitive processing speeds, and joint exposure to discrimination and economic stressors are risk factors for faster cognitive aging in midlife.