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Generation and age of immigration on later life cognitive performance in KHANDLE

Published online by Cambridge University Press:  23 December 2020

Oanh L. Meyer*
Department of Neurology, University of California Davis Health, Sacramento, CA, USA
Chloe W. Eng
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
Michelle J. Ko
Department of Public Health Sciences, University of California Davis, Davis, CA, USA
Michelle L. Chan
Department of Neurology, University of California Davis Health, Sacramento, CA, USA
Uyen Ngo
Department of Neurology, University of California Davis Health, Sacramento, CA, USA
Paola Gilsanz
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
M. Maria Glymour
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
Elizabeth Rose Mayeda
Department of Epidemiology, University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
Dan M. Mungas
Department of Neurology, University of California Davis Health, Sacramento, CA, USA
Rachel A. Whitmer
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA Department of Public Health Sciences, University of California Davis, Davis, CA, USA
Correspondence should be addressed to: Oanh L. Meyer, Department of Neurology, University of California Davis Health, 4860 Y St., Sacramento, CA 95817, USA. Phone: +1 916 734 5218. Email:



We examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans.


Baseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, and a prospective cohort is initiated in 2017.


Older adults in Northern California.


Our cohort consisted of Asians (n = 411) and Latinos (n = 340) who were on average 76 years old (SD = 6.8).


We used multivariable linear regression models to estimate associations between generational status and age at immigration (collapsed into one five-level variable) with measures of verbal episodic memory, semantic memory, and executive function, adjusting for age, gender, race and ethnicity, and own- and parental education.


Generational status and age at immigration were associated with cognitive outcomes in a graded manner. Compared to third-generation or higher immigrants, first-generation immigration in adulthood was associated with lower semantic memory (β = −0.96; 95% CI: −1.12, −0.81) than immigration in adolescence (β = −0.68; 95% CI: −0.96, −0.41) or childhood (β = −0.28; 95% CI: −0.49, −0.06). Moreover, immigration in adulthood was associated with lower executive function (β = −0.63; 95% CI: −0.78, −0.48) than immigration in adolescence (β = −0.49; 95% CI: −0.75, −0.23). Similarly, compared to third-generation individuals, first-generation immigrants had lower executive functioning scores.


Our study supports the notion that sociocontextual influences in early life impact later life cognitive scores. Longitudinal studies are needed to further clarify how immigration characteristics affect cognitive decline.

Original Research Article
© International Psychogeriatric Association 2020

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Abraído-Lanza, A. F., Armbrister, A. N., Flórez, K. R. and Aguirre, A. N. (2006). Toward a theory-driven model of acculturation in public health research. American Journal of Public Health, 96, 13421346. doi: 10.2105/AJPH.2005.064980 CrossRefGoogle Scholar
Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z. and Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 6875. doi: 10.2105/AJPH.2006.087205 CrossRefGoogle ScholarPubMed
American Community Survey (ACS). (n.d.). Available at:; last accessed 24 October 2019Google Scholar
Angel, R. J., Angel, J. L., Díaz Venegas, C. and Bonazzo, C. (2010). Shorter stay, longer life: age at migration and mortality among the older Mexican-origin population. Journal of Aging and Health, 22, 914931. doi: 10.1177/0898264310376540 CrossRefGoogle ScholarPubMed
Angel, R. J., Angel, J. L., Lee, G.-Y. and Markides, K. S. (1999). Age at migration and family dependency among older Mexican immigrants: recent evidence from the Mexican American EPESE. The Gerontologist, 39, 5965. doi: 10.1093/geront/39.1.59 CrossRefGoogle ScholarPubMed
Beard, H. A., Markides, K. S., Al Ghatrif, M., Kuo, Y.-F. and Raji, M. A. (2010). Trends in diabetes medication use and prevalence of geriatric syndromes in older Mexican Americans from 1993/1994 to 2004/2005. The Annals of Pharmacotherapy, 44, 13761383. doi: 10.1345/aph.1M724 CrossRefGoogle ScholarPubMed
Boone, K. B., Victor, T. L., Wen, J., Razani, J. and Pontón, M. (2007). The association between neuropsychological scores and ethnicity, language, and acculturation variables in a large patient population. Archives of Clinical Neuropsychology, 22, 355365. doi: 10.1016/j.acn.2007.01.010 CrossRefGoogle Scholar
Borenstein, A. R. et al. (2014). Incidence rates of dementia, Alzheimer disease, and vascular dementia in the Japanese American population in Seattle, WA: the Kame project. Alzheimer Disease & Associated Disorders, 28, 2329. doi: 10.1097/WAD.0b013e3182a2e32f CrossRefGoogle Scholar
Borson, S., Scanlan, J. M., Watanabe, J., Tu, S.-P. and Lessig, M. (2005). Simplifying detection of cognitive impairment: comparison of the mini-cog and mini-mental state examination in a multiethnic sample. Journal of the American Geriatrics Society, 53, 871874. doi: 10.1111/j.1532-5415.2005.53269.x CrossRefGoogle Scholar
Budhwani, H., Hearld, K. R. and Chavez-Yenter, D. (2015). Depression in racial and ethnic minorities: the impact of nativity and discrimination. Journal of Racial and Ethnic Health Disparities, 2, 3442. doi: 10.1007/s40615-014-0045-z CrossRefGoogle ScholarPubMed
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M-E. D., Beyeler, N. and Quesada, J. (2015). Immigration as a social determinant of health. Annual Review of Public Health, 36, 375392.CrossRefGoogle ScholarPubMed
Coffey, D. M., Marmol, L., Schock, L. and Adams, W. (2005). The influence of acculturation on the Wisconsin Card Sorting Test by Mexican Americans. Archives of Clinical Neuropsychology, 20, 795803. doi: 10.1016/j.acn.2005.04.009 CrossRefGoogle ScholarPubMed
Corlin, L. et al. (2014). Evidence for the healthy immigrant effect in older Chinese immigrants: a cross-sectional study. BMC Public Health, 14, 603.CrossRefGoogle ScholarPubMed
Crane, P. K. et al. (2008). Composite scores for executive function items: demographic heterogeneity and relationships with quantitative magnetic resonance imaging. Journal of the International Neuropsychological Society, 14, 746759. doi: 10.1017/S1355617708081162 CrossRefGoogle ScholarPubMed
Downer, B., Kumar, A., Veeranki, S. P., Mehta, H. B., Raji, M. and Markides, K. S. (2016). Mexican-American dementia nomogram: development of a dementia risk index for Mexican-American older adults. Journal of the American Geriatrics Society, 64, e265e269. doi: 10.1111/jgs.14531 CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198. doi: 10.1016/0022-3956(75)90026-6 CrossRefGoogle ScholarPubMed
Garcia, M. A. and Reyes, A. M. (2018). Physical functioning and disability trajectories by age of migration among Mexican elders in the United States. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 73, 12921302. doi: 10.1093/geronb/gbw167 Google ScholarPubMed
Garcia, M. A., Saenz, J., Downer, B. and Wong, R. (2018). The role of education in the association between race/ethnicity/nativity, cognitive impairment, and dementia among older adults in the United States. Demographic Research, 38, 155168. doi: 10.4054/DemRes.2018.38.6 CrossRefGoogle ScholarPubMed
Glass, T. A. and Balfour, J. L. (2003). Neighborhoods, aging, and functional limitations. In: Kawachi, I. and Berkman, L. F. (Eds.), Neighborhoods and Health (pp. 303334). New York: Oxford University Press.CrossRefGoogle Scholar
Gonzalez, H., Ceballos, M., Tarraf, W., West, B., Bowen, M. and Vega, W. (2009). The health of older Mexican Americans in the long run. American Journal of Public Health, 99, 18791885.CrossRefGoogle ScholarPubMed
Gordon, M. M. (1964). Assimilation in American Life: The Role of Race, Religion, and National Origins. New York: Oxford University Press.Google Scholar
Gordon, N. P. (2012). Similarity of the Kaiser Permanente senior member population in northern California to the non-Kaiser Permanente covered and general population of seniors in northern California: statistics from the 2009 California Health Interview Survey. Oakland, CA.Google Scholar
Grant, W. B. (1999). Dietary links to Alzheimer’s disease: 1999 update. Journal of Alzheimer’s Disease, 1, 197201. doi: 10.3233/JAD-1999-14-501 CrossRefGoogle ScholarPubMed
Graves, A. B. et al. (1996). Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington State: the Kame project. American Journal of Epidemiology, 144, 760771. doi: 10.1093/oxfordjournals.aje.a009000 CrossRefGoogle ScholarPubMed
Harris, J. G., Tulsky, D. S. and Schultheis, M. T. (2003). Assessment of the non-native English speaker: Assimilating history and research findings to guide clinical practice. In: Tulsky, D. S. et al. (Eds.), Clinical Interpretation of the WAIS-III and WMS-III (pp. 343390). Cambridge, MA: Academic Press.CrossRefGoogle Scholar
Hill, T. D., Angel, J. L. and Balistreri, K. S. (2012). Does the “healthy immigrant effect” extend to cognitive aging?  In: Angel, J. L., Torres-Gil, F. and Markides, K. (Eds.), Aging, Health, and Longevity in the Mexican-Origin Population (pp. 19–33). Berlin: Springer Science & Business Media.Google Scholar
Jang, Y., Choi, E., Rhee, M-K., Yoon, H., Park, N.S. and Chiriboga, D. A. (2020). Older Korean Americans’ concern about Alzheimer’s disease: the role of immigration-related factors and objective and subjective cognitive status. Aging & Mental Health. doi: 10.1080/13607863.2020.1720596 Google ScholarPubMed
Johnson, K. R. (2005). The forgotten repatriation of persons of Mexican ancestry and lessons for the War on Terror. Pace Law Review, 26. Available at: Google Scholar
Kemmotsu, N., Enobi, Y. and Murphy, C. (2013). Performance of older Japanese American adults on selected cognitive instruments. Journal of the International Neuropsychological Society, 19, 773781. doi:10.1017/S1355617713000520 CrossRefGoogle ScholarPubMed
Kim, I., Keovisai, M., Kim, W., Richards-Desai, S. and Yalim, A. C. (2019). Trauma, discrimination, and psychological distress across Vietnamese refugees and immigrants: a life course perspective. Community Mental Health Journal, 55, 385393. doi:10.1007/s10597-018-0268-2 CrossRefGoogle ScholarPubMed
Martinez-Miller, E. E. et al. (2020). Acculturation, cognitive performance and decline, and incident dementia/CIND: the Sacramento area Latino study on aging. American Journal of Epidemiology. doi: 10.1093/aje/kwaa088 CrossRefGoogle Scholar
Mather, M., Jacobsen, L. A. and Pollard, K. M. (2015). Aging in the United States. Population Bulletin, 70. Available at: Google Scholar
Mayeda, E. R., Glymour, M. M., Quesenberry, C. P. and Whitmer, R. A. (2016). Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer’s & Dementia, 12, 216224. doi:10.1016/j.jalz.2015.12.007 CrossRefGoogle ScholarPubMed
Meyer, O. L. et al. (2018). Neighborhood socioeconomic status and cognitive trajectories in a diverse longitudinal cohort. Clinical Gerontologist, 41, 8293.CrossRefGoogle Scholar
Molina, N. (2011). Borders, laborers, and racialized medicalization: Mexican immigration and U.S. public health practices in the 20th century. American Journal of Public Health, 101, 10241031.CrossRefGoogle ScholarPubMed
Mungas, D., Reed, B. R., Crane, P. K., Haan, M. N. and González, H. (2004). Spanish and English Neuropsychological Assessment Scales (SENAS): further development and psychometric characteristics. Psychological Assessment, 16, 347359. doi: 10.1037/1040-3590.16.4.347 CrossRefGoogle ScholarPubMed
Mungas, D., Reed, B. R., Farias, S. T. and DeCarli, C. (2005). Criterion-referenced validity of a neuropsychological test battery: equivalent performance in elderly Hispanics and non-Hispanic Whites. Journal of the International Neuropsychological Society, 11, 620630.CrossRefGoogle ScholarPubMed
Mungas, D., Reed, B. R., Haan, M. N. and González, H. (2005). Spanish and English neuropsychological assessment scales: relationship to demographics, language, cognition, and independent function. Neuropsychology, 19, 466475. doi: 10.1037/0894-4105.19.4.466 CrossRefGoogle ScholarPubMed
Patterson, K., Nestor, P. J. and Rogers, T. T. (2007). Where do you know what you know? The representation of semantic knowledge in the human brain. Nature Reviews Neurosciences, 8, 976987.CrossRefGoogle Scholar
Pew Research Center. (2019). Future immigration will change the face of America by 2065. Available at:; last accessed 3 February 2020Google Scholar
Pew Research Center. (n.d.). Key findings about U.S. immigrants. Available at:; last accessed 3 February 2020Google Scholar
Portes, A. (1996). The New Second Generation. New York: Russell Sage Foundation.Google Scholar
Portes, A. and Zhou, M. (1993). The new second generation: segmented assimilation and its variants. The Annals, 530, 7496.Google Scholar
Ramirez, M., Teresi, J. A., Holmes, D., Gurland, B. and Lantigua, R. (2006). Differential Item Functioning (DIF) and the Mini-Mental State Examination (MMSE): overview, sample, and issues of translation. Medical Care, 44, S95S106. Available at: CrossRefGoogle ScholarPubMed
Razani, J., Burciaga, J., Madore, M. and Wong, J. (2007). Effects of acculturation on tests of attention and information processing in an ethnically diverse group. Archives of Clinical Neuropsychology, 22, 333341. doi: 10.1016/j.acn.2007.01.008 CrossRefGoogle Scholar
Ruiz, J. M., Hamann, H. A., Mehl, M. R. and O’Connor, M.-F. (2016). The Hispanic health paradox: from epidemiological phenomenon to contribution opportunities for psychological science. Group Processes & Intergroup Relations, 19, 462476. doi: 10.1177/1368430216638540 CrossRefGoogle Scholar
Santos, O. A. et al. (2019). Ethnoracial differences in Alzheimer’s disease from the FLorida Autopsied Multi-Ethnic (FLAME) cohort. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 15, 635643. doi: 10.1016/j.jalz.2018.12.013 CrossRefGoogle ScholarPubMed
Singh, S., Schulz, A. J., Neighbors, H. W. and Griffith, D. M. (2017). Interactive effect of immigration-related factors with legal and discrimination acculturative stress in predicting depression among Asian American immigrants. Community Mental Health Journal, 53, 638646. doi: 10.1007/s10597-016-0064-9 CrossRefGoogle ScholarPubMed
Stepler, R. and Brown, A. (2016). A Statistical Portrait of Hispanics in the United States. Washington, DC: Pew Research Center. Available at: Google Scholar
Sutin, A. R., Stephan, Y., Carretta, H. and Terracciano, A. (2015). Perceived discrimination and physical, cognitive, and emotional health in older adulthood. The American Journal of Geriatric Psychiatry, 23, 171179. doi:10.1016/j.jagp.2014.03.007 CrossRefGoogle ScholarPubMed
Takaki, R. T. (2012). Strangers from a different shore: a history of Asian Americans (updated and revised). Available at Google Scholar
Tang, M. X. et al. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 4956. doi: 10.1212/wnl.56.1.49 CrossRefGoogle ScholarPubMed
Weden, M. M. et al. (2017). The Hispanic Paradox: race/ethnicity and nativity, immigrant enclave residence and cognitive impairment among older US adults. Journal of the American Geriatrics Society, 65, 10851091. doi: 10.1111/jgs.14806 CrossRefGoogle Scholar
Xu, H. et al. (2018). Migration and cognitive function: a conceptual framework for Global Health Research. Global Health Research and Policy, 3, 3434. doi: 10.1186/s41256-018-0088-5 CrossRefGoogle ScholarPubMed
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