Background The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, “stress burden”) on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator. Methods The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension. Results Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes. Conclusions Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities.

中文翻译：

---

美国黑人成年人压力负担和认知功能以及临床判断的认知结果的初步分析


背景 暴露于多种压力源和心理困扰的结合可能导致美国黑人痴呆风险的不成比例的负担。本研究估计了压力和心理困扰指数（即“压力负担”）对美国老年黑人成年人认知功能和临床判断的认知结果的影响，并检查了睡眠作为中介因素。方法 样本包括来自美国宾夕法尼亚州匹兹堡的 204 名黑人成年人 （79% 为女性;平均年龄 = 64 岁）。压力负担包括 2016 年评估的 3 项自我报告的压力和痛苦指标：歧视、心理困扰和创伤后压力。潜在的中介因素包括 2018 年活动记录仪评估的睡眠持续时间和效率。2019 年的认知电池和临床裁决评估了认知功能和临床裁决结果。在调整了社会人口统计学和高血压后，因果中介分析估计了压力负担和认知结果之间的直接影响，以及通过睡眠的间接影响。结果 较高的压力负担对较低的执行功能和视觉空间表现有显着的直接影响。然而，睡眠障碍对评估的任何认知功能领域都没有显着的间接影响 （即中介）。此外，对临床判断的结局没有显著的直接或间接影响。结论 多种压力源经常同时发生，并可能导致认知健康方面的种族差异。研究结果表明，在这个基于社区的美国老年黑人成年人样本中，较高的压力负担对执行和视觉空间领域的功能产生了负面影响。然而，没有证据表明睡眠起中介作用。 研究结果强调了继续努力确定压力负担和认知健康差异之间可改变途径的重要性。