Paper Title
ENHANCED COGNITIVE RESERVE AND DIABETES PREVENTION IN THE RIO GRANDE VALLEY LATINO POPULATION: THE IMPACT OF HIGH FAMILISM AND HEALTHY LIFESTYLE CHOICES

Abstract
I. INTRODUCTION Alzheimer's disease (AD) is a leading cause of dementia, affecting 60–80% of dementia patients, with significant impact on the elderly's daily life and well-being. Diabetes, particular type 2 diabetes constitutes 90–95% of diabetes. Both AD and diabetes represent a substantial health burden, particularly among the Latino population, who experience earlier AD onset, longer disease duration, and poorer cognitive outcomes at life's end compared to other ethnicities. Research suggests a concomitant development of AD and diabetes, linked through shared molecular pathways, cultural values, and lifestyle factors. Familism, one of cultural values, part of the "immigrant paradox," plays a critical role in diseases, though this area remains underexplored for cognitive reserve. Thus, this study aims to identify modifiable lifestyle factors and familism between AD and diabetes in under-researched Rio Grande Valley (RGV) Latino communities. Material and Methods: Self-reported Hispanic participants of total from communities in Brownsville, Harlingen, and Edinburg, Texas were recruited into this study. This study involves 333 participants enrolled since late 2019. Data collection includes lifestyle factors using Simple Lifestyle Indicator Questionnaire (SLIQ), social-demographic details, medical history, familism scales using Attitudinal Familism Scale, cognitive assessments using Montreal Cognitive Assessment (MoCA), and saliva samples for genetic analysis. Medical history and diagnoses of chronic conditions were based on self-report. Genetic screening focuses on markers in the APOEgene. Single nucleotide polymorphism (SNP) genotype was conducted using TaqMan Assay and QuantStudio™ 6 Real Time PCR system from ThermoFisher.Statistical analysis was performed via SPSS and SAS version 9.4 (Cary, NC. U.S.A.). We also examined the construct validity of familism in associations with diabetes and cognitive impairment by conducting factor analyses. Results:We observed a high prevalence of AD and MCI (60%), with a comorbidity rate of 32% for diabetes in the studied RGV Latino population.Higher levels of familism were negatively correlated with diabetes (P=0.014) and cognitive impairment (P=0.026), particularly with factor 2 of familism. Factor 4 also showed a negative association with cognitive impairment and a borderline association with diabetes. These associations remained significant after adjusting for gender and education using multiple logistic regression. Moreover, diabetes was significantly associated with low levels of physical activity, older age, and lower education. After adjustment, the association with low physical activity remained significant (P<0.05). II. DISCUSSION: Our study highlights a high prevalence of AD and MCI, along with their comorbidity with diabetes in the RGV Latino population. This is the first research to identify a higher level of familism as a protective factor, linked with cognitive reserve and diabetes prevention in RGV Latino community. Additionally, shared risk factors, such as older age, lower education levels, and reduced physical activity, were noted between AD and diabetes, emphasizing the importance of targeted interventions. These findings emphasize the importance of culturally sensitive strategies to improve health disparities and health outcomes in this underserved population. Further research is necessary to validate these findings and to develop effective interventions tailored to the unique needs of the RGV Latino community. Keywords - Alzheimer's disease, diabetes, Familism and Healthy Lifestyle, Rio Grande Valley Latino Population