Abstract
OBJECTIVE: This study examined how cognitive difficulties, an early marker of memory impairment and a potential precursor to Alzheimer's disease and related dementias, vary across U.S. states among Latinos aged 45 and older. METHODS: Using data from the 2008-2019 American Community Survey, we estimated logistic regression models to examine state-level differences in cognitive difficulties among Latinos aged 45 and older. We analyzed patterns within the pan-ethnic Latino population, stratified by nativity, Latino heritage, and country or region of origin. RESULTS: We observed substantial heterogeneity in the prevalence of cognitive difficulties among Latino populations across states and subgroups. Pan-ethnic Latino populations in Pennsylvania, Massachusetts, Michigan, Ohio, and New Mexico exhibited notably higher rates of cognitive difficulties. When disaggregated by nativity, U.S.-born Latino populations consistently reported higher levels of cognitive difficulties compared to their foreign-born counterparts. Among these, Puerto Ricans, Dominicans, and Cubans showed the highest prevalence in several states. Our findings also highlight that the intersection of nativity, heritage, and state-level context shapes distinct cognitive risk profiles within the Latino population. DISCUSSION: This study contributes to gerontological research by illuminating how structural, cultural, and geographic factors intersect to shape cognitive aging among diverse Latino populations. These findings underscore the importance of moving beyond pan-ethnic categorizations to understand cognitive health disparities within the Latino population. They also highlight the role of state-level sociopolitical environments in shaping cognitive health outcomes. Public health strategies should prioritize culturally and geographically tailored interventions, particularly in high-risk states, to improve access to cognitive screening and early diagnosis.