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Jennifer J. Manly, PhD

Jennifer J. Manly, PhD Jennifer J. Manly, PhD

Dr. Jennifer J. Manly is a neuropsychologist specializing in determinants of cognitive aging and risks for cognitive impairment among racially and ethnically diverse older adults. Dr. Manly and her research team aim to understand mechanisms of racial/ethnic disparities in cognitive aging and dementia and improve the diagnostic accuracy of neuropsychological tests, primarily among African American and Hispanic elders. Her work has been to clarify the independent influences of language, acculturation, educational experiences, racial socialization, and socioeconomic status on cognitive test performance, with the ultimate goal of understanding more about the relationship between culture and cognition. Ongoing work within the Manly lab is centered on four main themes of research:

1. Clarification of role of socioeconomic, cultural, and educational experience in cognitive aging and dementia risk

In order to accurately detect cognitive impairment, we must first know the “normal” or “expected” limits of neuropsychological test performance for individuals. Neuropsychologists have traditionally compared performance against normative values that adjust for age and years of education. However, using these methods, ethnic minorities are more likely to be misdiagnosed or misclassified as having cognitive impairment as compared to Caucasians (Neurology 1998;50:1238-45). Dr. Manly has been a leader in addressing this problem through examination of the role of cultural and educational experience in cognitive test performance. Most of this work has occurred with the help of the WHICAP study investigators, study staff, and participants. She found that within people of the same racial classification, those with cultural experiences that are dissimilar to “majority American culture” obtain lower scores on neuropsychological tests (J Int Neuropsychol Soc. 1998;4:291-302). Dr. Manly confirmed the importance of educational experience by showing that within African American elders, those who attended elementary school in Southern, rural, segregated schools performed more poorly on cognitive tests than those who attended school in integrated, Northern, urban schools, and that racial disparities in cognitive function are wider in the South than in the North and West (J Int Neuropsychol Soc. 2015;21:677-87). The effect of school setting was independent of years of education (highest grade achieved), suggesting that measuring education by years alone, and matching ethnic groups on this basis, is inadequate (J Gerontol B Psychol Sci Soc Sci. 2015;70:557-67). Dr. Manly demonstrated that African Americans were more likely to have reading skills significantly below their self-reported education level, and that this correlated with significantly lower scores on cognitive tests (J Int Neuropsychol Soc. 2002;8:341-8). The analysis of these variables set a new standard in neuropsychology for accounting for quality of education, not just quantity of formal schooling. Caitlin Watson, a member of Dr. Manly’s research team, demonstrated that discrepancies in quality of education can account for disparities in risk for incident Alzheimer’s disease between African Americans and Whites (Watson et al., in preparation).

2. Literacy, cognitive aging, and Alzheimer's disease

Dr. Manly’s work has shed light on link between level of literacy and risk for developing cognitive decline and AD. Dr. Manly demonstrated that among elders with no formal education, literacy level was a major predictor of cognitive test performance (J Int Neuropsychol Soc. 1999;5:191-202). When assessed over several years, those with low levels of literacy had a steeper decline in both immediate and delayed recall of a word list (J Clin Exp Neuropsychol. 2003;25:680-90.), and in the general cognitive domains of memory, executive function, and language as compared to those with high literacy.

3. Mild cognitive impairment in a diverse population cohort

Most of what we know about risks for Alzheimer’s disease and cognitive decline results from research on White, well-educated older adults who have presented to specialty memory disorders clinics. Dr. Manly’s research has contributed to our knowledge of the course and outcome of cognitive decline, Mild Cognitive Impairment, and dementia among ethnically and educationally diverse older adults (Brain Imaging Behav. 2012;6:540-50). She implemented criteria for Mild Cognitive Impairment, which is the transition state between normal aging and AD, among ethnically diverse English and Spanish speaking elders (Arch Neurol. 2005;62:1739-46), and then described the longitudinal outcomes and incidence of MCI in the same cohort (Ann Neurol. 2008;63:494–506.)

4. Bilingualism and cognitive aging and dementia

Several research studies have reported a relationship between bilingual status and lower risk of developing Alzheimer’s disease, or delayed onset of the disease. However, this prior work has almost exclusively been carried out in selected clinical samples using cross-sectional data. Dr. Laura Zahodne, a postdoctoral fellow and member of Dr. Manly’s research team (Zahodne et al, Neuropsychology. 2014;28:238–246), demonstrated that in a longitudinal, prospective study that allowed for direct, standardized observation of cognitive performance and determination of date of dementia onset among bilingual and monolingual older adults matched on key experiential variables, there was no advantage of bilingualism for maintenance of cognitive function or development of dementia.

Members of the Dr. Manly's Laboratory include, from left to right, Caitlin Wei-Ming Watson, Iris Santos, Laura Zahodne, Douglas Mendez, Laiss Bertola de Moura Ricardo, Michelle Martinez, Didi Sanchez, and Sonia Seehra. Not pictured: Greysi Sherwood, Milou Angevaare, David Christian, and Aishwarya Raja.

Jennifer J. Manly, PhD
Associate Professor of Neuropsychology (in Neurology, the Gertrude H. Sergievsky Center, and the Taub Institute for Research on Alzheimer's disease and the Aging Brain)

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