In recent years, more attention has been given to cultural predictors of Alzheimer's disease and related dementias (ADRD) risk. Yet, research has overlooked the potential risk conferred by U.S. cultures of honor. There is ample reason to suspect that honor-oriented states are at greater risk for ADRD, as many of the characteristics of honor-oriented states are also risk factors for ADRD (e.g., rurality, economic precariousness) and norms within honor cultures (e.g., risk taking, military enlistment, intimate partner violence) may elevate the chance of experiencing neurocognitive ADRD risk factors, like traumatic brain injury (TBI) and subjective cognitive decline (SCD). The present work examined the extent to which statewide honor-orientation predicted estimates of unintentional TBI deaths (2001-2019), SCD (2015-2019), and ADRD deaths (1999-2019) among non-Hispanic Whites. We controlled for period-matched variables known to be associated with honor cultures and ADRD (e.g., rurality, economic precariousness). After controlling for covariates, we observed that more honor-oriented states had higher unintentional TBI death rates (β = 0.39, p = .016), SCD (β = 0.58, p = .001), and ADRD death rates (β = 0.49, p = .030). Findings suggest that the norms and values of honor cultures may confer higher risk for TBI, SCD, and ADRD. Implications for educational, identification, and intervention efforts are discussed.

Keywords: Alzheimer's disease; Culture of honor; Dementia; Subjective cognitive decline; Traumatic brain injury.

© 2024 The Authors.

近年来，人们对阿尔茨海默病及相关痴呆症（ADRD）风险的文化预测因素给予了更多关注。然而，研究忽视了美国荣誉文化可能带来的潜在风险。有充分的理由怀疑以荣誉为导向的州在ADRD方面的风险更大，因为许多荣誉导向州的特点也是ADRD的风险因素（例如，农村地区、经济不稳定），而荣誉文化的规范（如冒险行为、参军、亲密伴侣暴力）可能会增加经历神经认知ADRD风险因素的可能性，比如创伤性脑损伤（TBI）和主观认知下降（SCD）。本研究考察了全州范围内的荣誉导向程度是否预测非西班牙裔白人2001年至2019年的意外TBI死亡率、2015年至2019年的SCD以及1999年至2019年的ADRD死亡率。我们控制了与荣誉文化及ADRD相关的同期匹配变量（如农村地区和经济不稳定）。在控制协变量后，我们发现更加以荣誉为导向的州意外TBI死亡率更高（β= 0.39, p = .016），SCD更严重（β= 0.58, p = .001）以及ADRD死亡率更高（β= 0.49, p = .030）。研究结果表明，荣誉文化的规范和价值观可能会增加TBI、SCD及ADRD的风险。讨论了教育、识别和干预措施的意义。

关键词：阿尔茨海默病；荣誉文化；痴呆症；主观认知下降；创伤性脑损伤。