Elevated Familism as a Protective Factor Against Type 2 Diabetes and Alzheimer’s Disease in the RGV Hispanic Communities

Background: Alzheimer’s Disease (AD) and Type 2 Diabetes Mellitus (T2DM) are significant contributors to cognitive decline, disproportionately affecting Hispanic/Latino populations. T2DM increases the risk of AD and dementia through mechanisms such as insulin resistance, chronic inflammation, and neurodegeneration (Umegaki, 2014; González et al., 2020). Social determinants such as socioeconomic status, healthcare access, and cultural factors, including familism, exacerbating disease progression (Vega et al., 2017). Familism—a cultural value emphasizing strong family ties, loyalty, and caregiving—may play a dual role, both as a factor shaping disease management and as a potential protective element. Elevated familism can foster supportive family networks that promote healthier lifestyles, encourage adherence to medical treatments, and provide care for individuals with chronic illnesses like T2DM and AD. These protective effects may be particularly impactful in Hispanic communities of the Rio Grande Valley (RGV), where familial bonds are often central to daily life. While T2DM is linked to a higher risk of mild cognitive impairment (MCI) and cognitive decline in Hispanics/Latinos (González et al., 2020), the presence of robust familial support may mitigate some of these risks by improving health outcomes and providing emotional and practical support during illness. This study explores the intersection of T2DM and AD in Hispanic/Latino communities, particularly examining the protective effects of elevated familism within the RGV. It aims to identify genetic, social, and environmental risk factors while developing targeted interventions to mitigate health disparities and enhance the role of familial networks in promoting cognitive health. Methods: The study included Hispanic participants aged 45 and older, a group at increased risk for Alzheimer’s Disease (AD), Type 2 Diabetes Mellitus (T2DM), and cognitive impairment. Data collection involved interviews to assess demographics (age, gender, and socioeconomic status), medical history, lifestyle factors (diet, physical activity, and sleep), and cultural values like familism using the Attitudinal Familism Scale. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA), and lifestyle behaviors were assessed using the Simple Lifestyle Indicator Questionnaire (SLIQ). Saliva samples were collected using a DNA Genotek kit for genetic analysis. DNA was extracted and genotyped through Polymerase Chain Reaction (PCR) with the TaqMan assay, targeting genetic markers such as the APOE ε4 allele. Statistical analyses using SPSS explored relationships between APOE genotypes, education levels, AD, T2DM, and cognitive impairment. The study aimed to highlight the combined effects of genetic, lifestyle, and cultural factors on cognitive health in the Hispanic community, particularly the potential protective role of familism. Results: A significant correlation was observed between APOE genotypes and sugar-related issues, with a p-value of 0.030, underscoring a genetic influence on metabolic health. Specifically, individuals carrying the APOE ε4 allele exhibited a higher predisposition to developing Type 2 Diabetes Mellitus (T2DM). This finding highlights the interplay between genetic susceptibility and metabolic disorders, suggesting that APOE genotypes may serve as a biological marker for assessing T2DM risk. Higher education levels emerged as a protective factor against Alzheimer’s Disease (AD), indicating that education may enhance cognitive reserve, potentially mitigating the effects of neurodegeneration. Conversely, the analysis revealed no significant relationship between AD and sugar-related problems, implying that while T2DM and AD share overlapping risk pathways, their interactions with cognitive decline differ in this population. In the Hispanic community, cognitive impairment (CI) appeared more strongly linked to AD than T2DM. This emphasizes the critical need to address AD-specific risk factors when evaluating cognitive health outcomes in this group. Furthermore, age and familism (Factor 4) were identified as key predictors of cognitive outcomes, as demonstrated in Table 1. Familism, a cultural factor reflecting the importance of family values and social support, may influence cognitive health through enhanced psychosocial resilience, while age remains a primary determinant of cognitive decline. These findings provide a comprehensive perspective on the multifaceted contributors to CI in Hispanic populations, combining genetic, educational, cultural, and biological insights. As shown in Table 2, Factor 4 of familism demonstrates significant and meaningful relationships with both cognitive impairment and diabetes. This factor reflects a deeper sense of familial responsibility and interconnectedness, which appears to influence health outcomes in unique ways. Specifically, there is a strong positive association between Factor 4 and cognitive impairment, suggesting that higher levels of familism in this context are linked to increased cognitive challenges. This could be due to the intense caregiving roles and expectations placed on individuals within the family, which may contribute to stress and strain on cognitive functions. Additionally, Factor 4 shows a significant negative relationship with diabetes, indicating that increased familism may be protective against the development of diabetes. This suggests that familial support and interconnectedness may play a crucial role in managing metabolic health, perhaps through healthier lifestyle choices, emotional well-being, and shared responsibility for health within the family. In contrast, Factors 1, 2, and 3 do not exhibit significant relationships with cognitive impairment or diabetes. This underscores the unique role of Factor 4 in understanding the interplay between familial support and health outcomes within the Hispanic community. Overall, Factor 4 highlights how specific dimensions of familism can influence both cognitive and physical health, offering valuable insights for health interventions tailored to the Hispanic population. Conclusion: This study underscores the important link between Type 2 Diabetes Mellitus (T2DM) and cognitive impairment, highlighting the protective role of familism within Hispanic communities in the Rio Grande Valley (RGV). Familism has been shown to mitigate some of the risks associated with T2DM and cognitive decline, providing a valuable resource for managing these complex health issues. Addressing both genetic and social factors is essential for improving cognitive health and reducing the risk of Alzheimer’s Disease (AD). The study reveals how familial networks influence health outcomes by promoting healthier lifestyles, encouraging adherence to medical treatments, and offering emotional and practical support. Additionally, education was found to serve as a protective factor against AD, suggesting that increasing cognitive reserve through formal education can help manage neurodegenerative risks. This reinforces the importance of combining social and cultural factors with scientific research to develop holistic approaches to healthcare. Ultimately, this research highlights the need for targeted interventions that consider both genetic predispositions and the cultural context of familial relationships. By fostering strong familial support while addressing the challenges associated with caregiving, healthcare strategies can better address health disparities in Hispanic communities, promoting better outcomes for those at risk for cognitive decline.

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