Cognitive Impairment and Depressive Symptoms Among Low-Income Hispanic and Non-Hispanic White Older Adults: A Cross-Sectional Analysis Original Research
Main Article Content
Keywords
Aging, Cognitive functioning , Mental health, Minority Populations
Abstract
Introduction: Hispanic older adults represent a rapidly growing demographic in the United States and may be disproportionately affected by cognitive impairment and depression. This study aimed to examine ethnic differences in the prevalence of cognitive impairment and depression among low-income Hispanic and non-Hispanic White older adults, and to explore the relationship between cognitive impairment and depressive symptoms within these groups.
Methods: This cross-sectional study included 157 older adults (age = 76.3 ± 6.7 years, female = 133), recruited from independent living facilities and low-income community centers in Central Florida. The sample consisted of Hispanic (n = 91) and non-Hispanic White (n = 66) older adults. Cognitive impairment was assessed using the Memory Impairment Screen, and depression was measured using the Patient Health Questionnaire-9 (PHQ-9). Chi-square tests and Mann-Whitney U tests were used to analyze group differences.
Results: A significant difference in cognitive impairment prevalence was found between ethnic groups (χ² = 7.528, p = .006), with Hispanic participants showing higher rates. However, depression scores did not significantly differ between Hispanic and non-Hispanic White participants (U = 2930.50, p = .79), nor between those with and without cognitive impairment within each ethnic group (Hispanic: U = 839.00, p = .71; non-Hispanic White: U = 227.50, p = .93).
Conclusions: Cognitive impairment is more prevalent among low-income Hispanic older adults compared to their non-Hispanic White counterparts. These findings emphasize the need for culturally tailored interventions to improve cognitive health care access for older adults.
References
References
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2. 2020 profile of Hispanic Americans age 65 and older. (2021).
3. Cabassa LJ, Zayas LH, Hansen MC. Latino Adults’ Access to Mental Health Care: A Review of Epidemiological Studies. Adm Policy Ment Health. 2006/05// 2006;33(3):316-330. doi:10.1007/s10488-006-0040-8
4. Sun H-L, Chen P, Bai W, et al. Depressive Symptoms and Cognitive Function in Older Adults: A Cross‐Lagged Network Analysis. Depression and Anxiety. 2024;2024(1):6166775.
5. Gupta S. Racial and ethnic disparities in subjective cognitive decline: a closer look, United States, 2015–2018. BMC Public Health. 2021/12// 2021;21(1):1173. doi:10.1186/s12889-021-11068-1
6. Velez Ortiz D, Ransom N, Rivera E, et al. Specific cultural traits of the precarity of older Latinos living alone with cognitive impairment in the San Francisco Bay Area. Aging & Mental Health. 2024/09/27/ 2024:1-10. doi:10.1080/13607863.2024.2407180
7. Jang Y, Chiriboga DA, Herrera JR, Martinez Tyson D, Schonfeld L. Attitudes Toward Mental Health Services in Hispanic Older Adults: The Role of Misconceptions and Personal Beliefs. Community Mental Health Journal. 2011/04/01/ 2011;47(2):164-170. doi:10.1007/s10597-009-9274-8
8. Boza-Calvo C, Faustin A, Zhang Y, et al. Two-Year Longitudinal Outcomes of Subjective Cognitive Decline in Hispanics Compared to Non-hispanic Whites. Journal of Geriatric Psychiatry and Neurology. 2025;38(1):23-31.
9. Persin MJ, Payen A, Bateman JR, Alessi MG, Price BC, Bennett JM. Depressive Symptoms Affect Cognitive Functioning from Middle to Late Adulthood: Ethnoracial Minorities Experience Greater Repercussions. Journal of Racial and Ethnic Health Disparities. 2024:1-11.
10. Alvarez P, Rengifo J, Emrani T, Gallagher-Thompson D. Latino Older Adults and Mental Health: A Review and Commentary. Clinical Gerontologist. 2014/01// 2014;37(1):33-48. doi:10.1080/07317115.2013.847514
11. Luchsinger JA, Reitz C, Patel B, Tang M-X, Manly JJ, Mayeux R. Relation of Diabetes to Mild Cognitive Impairment. Arch Neurol. 2007/04/01/ 2007;64(4):570. doi:10.1001/archneur.64.4.570
12. Whetung C, Gonzales E. Modifiable Factors Associated with Cognitive Health Among Indigenous, Hispanic, Black, and White Older Adults. Hispanic, Black, and White Older Adults.
13. Escobedo LE, Cervantes L, Havranek E. Barriers in healthcare for Latinx patients with limited English proficiency—a narrative review. Journal of general internal medicine. 2023;38(5):1264-1271.
14. Malatyali A, Sagna De Main A, Cidav T, Komalasari R, Xie R, Thiamwong L. Health Disparities in Cognitive Impairment and Dementia: Role of Social Strain, Depression, and C-Reactive Protein. Gerontology and Geriatric Medicine. 2023;9:23337214231215274. doi:10.1177/23337214231215274
15. Guo Y, Pai M, Xue B, Lu W. Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: evidence from the Health and Retirement Study in the United States. Journal of affective disorders. 2023;338:449-458.
16. Quiñones AR, Chen S, Nagel CL, et al. Trajectories of cognitive functioning in later life: Disparities by race/ethnicity, educational attainment, sex, and multimorbidity combinations. SSM Popul Health. Jun 2022;18:101084. doi:10.1016/j.ssmph.2022.101084
17. Wong CG, Miller JB, Zhang F, et al. Evaluation of neighborhood-level disadvantage and cognition in Mexican American and non-Hispanic White adults 50 years and older in the US. JAMA network open. 2023;6(8):e2325325-e2325325.
18. Thiamwong L, Xie R, Park J-H, Lighthall N, Loerzel V, Stout J. Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations: protocol for a clustered randomized controlled trial. JMIR research protocols. 2023;12(1):e51899.
19. Poverty Thresholds Accessed 10/08/2025, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html
20. Storey JE, Rowland JT, Basic D, Conforti DA, Dickson HG. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr. Mar 2004;16(1):13-31. doi:10.1017/s1041610204000043
21. Buschke H, Kuslansky G, Katz M, et al. Screening for dementia with the Memory Impairment Screen. Neurology. 1999/01// 1999;52(2):231-231. doi:10.1212/WNL.52.2.231
22. Böhm P, Peña-Casanova J, Gramunt N, Manero RM, Terrón C, Quiñones-Ubeda S. [Spanish version of the Memory Impairment Screen (MIS): normative data and discriminant validity]. Neurologia. 2005/10// 2005;20(8):402-411.
23. Kuslansky G, Buschke H, Katz M, Sliwinski M, Lipton RB. Screening for Alzheimer's Disease: The Memory Impairment Screen Versus the Conventional Three‐Word Memory Test. Journal of the American Geriatrics Society. 2002/06// 2002;50(6):1086-1091. doi:10.1046/j.1532-5415.2002.50265.x
24. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001/09// 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x
25. Phelan E, Williams B, Meeker K, et al. A study of the diagnostic accuracy of the PHQ-9 in primary care elderly. BMC Fam Pract. 2010/12// 2010;11(1):63. doi:10.1186/1471-2296-11-63
26. Familiar I, Ortiz‐Panozo E, Hall B, et al. Factor structure of the Spanish version of the Patient Health Questionnaire‐9 in Mexican women. Int J Methods Psych Res. 2015/03// 2015;24(1):74-82. doi:10.1002/mpr.1461
27. IBM SPSS Statistics for Windows. Version 29.0. 2022.
28. González HM, Tarraf W, Schneiderman N, et al. Prevalence and correlates of mild cognitive impairment among diverse Hispanics/Latinos: Study of Latinos‐Investigation of Neurocognitive Aging results. Alzheimer's & Dementia. 2019/12// 2019;15(12):1507-1515. doi:10.1016/j.jalz.2019.08.202
29. Zhong T, Li S, Liu P, Wang Y, Chen L. The impact of education and occupation on cognitive impairment: a cross-sectional study in China. Frontiers in Aging Neuroscience. 2024;16:1435626.
30. Yin J, John A, Cadar D. Bidirectional associations of depressive symptoms and cognitive function over time. JAMA Network Open. 2024;7(6):e2416305-e2416305.
31. Brewer KB, Washburn M, Yu M, et al. Stigma toward families with mental health problems in Latino communities. Families in Society. 2024:10443894241237018.
32. Jimenez DE, Bartels SJ, Cardenas V, Alegría M. Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. Int J Geriat Psychiatry. 2013/10// 2013;28(10):1061-1068. doi:10.1002/gps.3928
33. Lopez V, Sanchez K, Killian MO, Eghaneyan BH. Depression screening and education: an examination of mental health literacy and stigma in a sample of Hispanic women. BMC Public Health. 2018;18(1):646.
34. Caplan S. Intersection of Cultural and Religious Beliefs About Mental Health: Latinos in the Faith-Based Setting. Hisp Health Care Int. Mar 2019;17(1):4-10. doi:10.1177/1540415319828265
35. Grieb SM, Platt R, Vazquez MG, Alvarez K, Polk S. Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland. J Immigr Minor Health. Oct 2023;25(5):999-1007. doi:10.1007/s10903-023-01488-z
36. Uebelacker LA, Marootian BA, Pirraglia PA, et al. Barriers and facilitators of treatment for depression in a latino community: a focus group study. Community Ment Health J. Feb 2012;48(1):114-26. doi:10.1007/s10597-011-9388-7
37. Martínez Pincay IE, Guarnaccia PJ. "It's like going through an earthquake": anthropological perspectives on depression among Latino immigrants. J Immigr Minor Health. Jan 2007;9(1):17-28. doi:10.1007/s10903-006-9011-0
38. Lewis-Fernandez R, Das AK, Alfonso C, Weissman MM, Olfson M. Depression in US Hispanics: diagnostic and management considerations in family practice. The Journal of the American Board of Family Practice. 2005;18(4):282-296.
39. Martinez A, Teklu SM, Tahir P, Garcia ME. Validity of the Spanish-Language Patient Health Questionnaires 2 and 9: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023/10/17/ 2023;6(10):e2336529. doi:10.1001/jamanetworkopen.2023.36529
40. Ruiz-Grosso P, Loret De Mola C, Vega-Dienstmaier JM, et al. Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: A Comparative Validation Study. PLoS ONE. 2012/10/08/ 2012;7(10):e45413. doi:10.1371/journal.pone.0045413
41. Ruiz JM, Hamann HA, Mehl MR, O’Connor M-F. The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. Group Processes & Intergroup Relations. 2016;19(4):462-476.
42. Hernandez CM, Moreno O, Garcia-Rodriguez I, Fuentes L, Nelson T. The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans. Health Psychol Behav Med. 2022;10(1):180-198. doi:10.1080/21642850.2022.2032714
43. Weden MM, Miles JNV, Friedman E, et al. The Hispanic Paradox: Race/Ethnicity and Nativity, Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults. J Am Geriatr Soc. May 2017;65(5):1085-1091. doi:10.1111/jgs.14806
1. Hernandez R, Cheung E, Liao M, Boughton SW, Tito LG, Sarkisian C. The Association Between Depressive Symptoms and Cognitive Functioning in Older Hispanic/Latino Adults Enrolled in an Exercise Intervention: Results From the “¡Caminemos!” Study. J Aging Health. 2018/07// 2018;30(6):843-862. doi:10.1177/0898264317696776
2. 2020 profile of Hispanic Americans age 65 and older. (2021).
3. Cabassa LJ, Zayas LH, Hansen MC. Latino Adults’ Access to Mental Health Care: A Review of Epidemiological Studies. Adm Policy Ment Health. 2006/05// 2006;33(3):316-330. doi:10.1007/s10488-006-0040-8
4. Sun H-L, Chen P, Bai W, et al. Depressive Symptoms and Cognitive Function in Older Adults: A Cross‐Lagged Network Analysis. Depression and Anxiety. 2024;2024(1):6166775.
5. Gupta S. Racial and ethnic disparities in subjective cognitive decline: a closer look, United States, 2015–2018. BMC Public Health. 2021/12// 2021;21(1):1173. doi:10.1186/s12889-021-11068-1
6. Velez Ortiz D, Ransom N, Rivera E, et al. Specific cultural traits of the precarity of older Latinos living alone with cognitive impairment in the San Francisco Bay Area. Aging & Mental Health. 2024/09/27/ 2024:1-10. doi:10.1080/13607863.2024.2407180
7. Jang Y, Chiriboga DA, Herrera JR, Martinez Tyson D, Schonfeld L. Attitudes Toward Mental Health Services in Hispanic Older Adults: The Role of Misconceptions and Personal Beliefs. Community Mental Health Journal. 2011/04/01/ 2011;47(2):164-170. doi:10.1007/s10597-009-9274-8
8. Boza-Calvo C, Faustin A, Zhang Y, et al. Two-Year Longitudinal Outcomes of Subjective Cognitive Decline in Hispanics Compared to Non-hispanic Whites. Journal of Geriatric Psychiatry and Neurology. 2025;38(1):23-31.
9. Persin MJ, Payen A, Bateman JR, Alessi MG, Price BC, Bennett JM. Depressive Symptoms Affect Cognitive Functioning from Middle to Late Adulthood: Ethnoracial Minorities Experience Greater Repercussions. Journal of Racial and Ethnic Health Disparities. 2024:1-11.
10. Alvarez P, Rengifo J, Emrani T, Gallagher-Thompson D. Latino Older Adults and Mental Health: A Review and Commentary. Clinical Gerontologist. 2014/01// 2014;37(1):33-48. doi:10.1080/07317115.2013.847514
11. Luchsinger JA, Reitz C, Patel B, Tang M-X, Manly JJ, Mayeux R. Relation of Diabetes to Mild Cognitive Impairment. Arch Neurol. 2007/04/01/ 2007;64(4):570. doi:10.1001/archneur.64.4.570
12. Whetung C, Gonzales E. Modifiable Factors Associated with Cognitive Health Among Indigenous, Hispanic, Black, and White Older Adults. Hispanic, Black, and White Older Adults.
13. Escobedo LE, Cervantes L, Havranek E. Barriers in healthcare for Latinx patients with limited English proficiency—a narrative review. Journal of general internal medicine. 2023;38(5):1264-1271.
14. Malatyali A, Sagna De Main A, Cidav T, Komalasari R, Xie R, Thiamwong L. Health Disparities in Cognitive Impairment and Dementia: Role of Social Strain, Depression, and C-Reactive Protein. Gerontology and Geriatric Medicine. 2023;9:23337214231215274. doi:10.1177/23337214231215274
15. Guo Y, Pai M, Xue B, Lu W. Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: evidence from the Health and Retirement Study in the United States. Journal of affective disorders. 2023;338:449-458.
16. Quiñones AR, Chen S, Nagel CL, et al. Trajectories of cognitive functioning in later life: Disparities by race/ethnicity, educational attainment, sex, and multimorbidity combinations. SSM Popul Health. Jun 2022;18:101084. doi:10.1016/j.ssmph.2022.101084
17. Wong CG, Miller JB, Zhang F, et al. Evaluation of neighborhood-level disadvantage and cognition in Mexican American and non-Hispanic White adults 50 years and older in the US. JAMA network open. 2023;6(8):e2325325-e2325325.
18. Thiamwong L, Xie R, Park J-H, Lighthall N, Loerzel V, Stout J. Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations: protocol for a clustered randomized controlled trial. JMIR research protocols. 2023;12(1):e51899.
19. Poverty Thresholds Accessed 10/08/2025, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html
20. Storey JE, Rowland JT, Basic D, Conforti DA, Dickson HG. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr. Mar 2004;16(1):13-31. doi:10.1017/s1041610204000043
21. Buschke H, Kuslansky G, Katz M, et al. Screening for dementia with the Memory Impairment Screen. Neurology. 1999/01// 1999;52(2):231-231. doi:10.1212/WNL.52.2.231
22. Böhm P, Peña-Casanova J, Gramunt N, Manero RM, Terrón C, Quiñones-Ubeda S. [Spanish version of the Memory Impairment Screen (MIS): normative data and discriminant validity]. Neurologia. 2005/10// 2005;20(8):402-411.
23. Kuslansky G, Buschke H, Katz M, Sliwinski M, Lipton RB. Screening for Alzheimer's Disease: The Memory Impairment Screen Versus the Conventional Three‐Word Memory Test. Journal of the American Geriatrics Society. 2002/06// 2002;50(6):1086-1091. doi:10.1046/j.1532-5415.2002.50265.x
24. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001/09// 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x
25. Phelan E, Williams B, Meeker K, et al. A study of the diagnostic accuracy of the PHQ-9 in primary care elderly. BMC Fam Pract. 2010/12// 2010;11(1):63. doi:10.1186/1471-2296-11-63
26. Familiar I, Ortiz‐Panozo E, Hall B, et al. Factor structure of the Spanish version of the Patient Health Questionnaire‐9 in Mexican women. Int J Methods Psych Res. 2015/03// 2015;24(1):74-82. doi:10.1002/mpr.1461
27. IBM SPSS Statistics for Windows. Version 29.0. 2022.
28. González HM, Tarraf W, Schneiderman N, et al. Prevalence and correlates of mild cognitive impairment among diverse Hispanics/Latinos: Study of Latinos‐Investigation of Neurocognitive Aging results. Alzheimer's & Dementia. 2019/12// 2019;15(12):1507-1515. doi:10.1016/j.jalz.2019.08.202
29. Zhong T, Li S, Liu P, Wang Y, Chen L. The impact of education and occupation on cognitive impairment: a cross-sectional study in China. Frontiers in Aging Neuroscience. 2024;16:1435626.
30. Yin J, John A, Cadar D. Bidirectional associations of depressive symptoms and cognitive function over time. JAMA Network Open. 2024;7(6):e2416305-e2416305.
31. Brewer KB, Washburn M, Yu M, et al. Stigma toward families with mental health problems in Latino communities. Families in Society. 2024:10443894241237018.
32. Jimenez DE, Bartels SJ, Cardenas V, Alegría M. Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. Int J Geriat Psychiatry. 2013/10// 2013;28(10):1061-1068. doi:10.1002/gps.3928
33. Lopez V, Sanchez K, Killian MO, Eghaneyan BH. Depression screening and education: an examination of mental health literacy and stigma in a sample of Hispanic women. BMC Public Health. 2018;18(1):646.
34. Caplan S. Intersection of Cultural and Religious Beliefs About Mental Health: Latinos in the Faith-Based Setting. Hisp Health Care Int. Mar 2019;17(1):4-10. doi:10.1177/1540415319828265
35. Grieb SM, Platt R, Vazquez MG, Alvarez K, Polk S. Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland. J Immigr Minor Health. Oct 2023;25(5):999-1007. doi:10.1007/s10903-023-01488-z
36. Uebelacker LA, Marootian BA, Pirraglia PA, et al. Barriers and facilitators of treatment for depression in a latino community: a focus group study. Community Ment Health J. Feb 2012;48(1):114-26. doi:10.1007/s10597-011-9388-7
37. Martínez Pincay IE, Guarnaccia PJ. "It's like going through an earthquake": anthropological perspectives on depression among Latino immigrants. J Immigr Minor Health. Jan 2007;9(1):17-28. doi:10.1007/s10903-006-9011-0
38. Lewis-Fernandez R, Das AK, Alfonso C, Weissman MM, Olfson M. Depression in US Hispanics: diagnostic and management considerations in family practice. The Journal of the American Board of Family Practice. 2005;18(4):282-296.
39. Martinez A, Teklu SM, Tahir P, Garcia ME. Validity of the Spanish-Language Patient Health Questionnaires 2 and 9: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023/10/17/ 2023;6(10):e2336529. doi:10.1001/jamanetworkopen.2023.36529
40. Ruiz-Grosso P, Loret De Mola C, Vega-Dienstmaier JM, et al. Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: A Comparative Validation Study. PLoS ONE. 2012/10/08/ 2012;7(10):e45413. doi:10.1371/journal.pone.0045413
41. Ruiz JM, Hamann HA, Mehl MR, O’Connor M-F. The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. Group Processes & Intergroup Relations. 2016;19(4):462-476.
42. Hernandez CM, Moreno O, Garcia-Rodriguez I, Fuentes L, Nelson T. The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans. Health Psychol Behav Med. 2022;10(1):180-198. doi:10.1080/21642850.2022.2032714
43. Weden MM, Miles JNV, Friedman E, et al. The Hispanic Paradox: Race/Ethnicity and Nativity, Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults. J Am Geriatr Soc. May 2017;65(5):1085-1091. doi:10.1111/jgs.14806
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Jan 2, 2026
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Cognitive Impairment and Depressive Symptoms Among Low-Income Hispanic and Non-Hispanic White Older Adults: A Cross-Sectional Analysis: Original Research. (2026). Research in Health and Medicine, 6(1). https://doi.org/10.53520/rhm2026.104176
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Copyright, 2026 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.