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Comment & Response
August 2015

Diabetes Mellitus and Cognitive Resilience—Reply

Author Affiliations
  • 1Research Service, San Francisco VA Medical Center, University of California, San Francisco
  • 2 Department of Psychiatry, University of California, San Francisco
  • 3Department Neurology, University of California, San Francisco
  • 4Epidemiology and Biostatistics, University of California, San Francisco
  • 5San Francisco VA Medical Center, San Francisco, California
JAMA Neurol. 2015;72(8):949-950. doi:10.1001/jamaneurol.2015.1319

In Reply We thank Dr Kawada for his comments and interest in our study.1 We would first like to clarify our findings. In brief, our study1 investigated factors associated with cognitive resilience among black and white older adult apolipoprotein E (APOE) ɛ4 carriers. We examined the association between a number of participant characteristics and health and lifestyle factors with cognitive resilience, separately by race. Our primary analysis used random forest analysis, a multivariable technique that enabled us to identify the strongest predictors of cognitive resilience among the relatively large set of variables we examined. Factors most strongly associated with cognitive resilience among white APOE ɛ4 carriers were (1) absence of recent negative life events, (2) higher literacy, (3) older age, (4) higher education, and (5) more time spent reading. Among black APOE ɛ4 carriers, factors most strongly associated with cognitive resilience were (1) higher literacy, (2) higher education, (3) being female, and (4) the absence of diabetes mellitus.

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