While global frameworks highlight modifiable risk factors for cognitive decline, evidence on how these risks affect diverse populations remains limited. This study determines the prevalence of probable and possible dementia, identifies primary predictors, and investigates risk variations across racial and ethnic groups in a nationally representative sample.

Using a sample of 7,574 older adults from the 2023 National Health and Aging Trends Study (NHATS), cognitive status was classified as probable, possible, or no dementia. Survey-weighted multinomial logistic regression models with interaction terms examined conditional effects of age, health conditions, and sensory corrections across demographics.

Advanced age, low education, stroke, falls, and depression/anxiety were associated with higher Odds of possible and probable dementia (Prb-D), while female, vision and hearing aid use lowered Prb-D odds. Hispanic adults aged 85 and older faced a 60.2% predicted probability of Prb-D, compared to 35.1% for Non-Hispanic (NH) White adults. Low education disproportionately increased Prb-D prevalence, especially among Hispanics. Among hearing aid users, NH White and NH Black adults showed lower of Prb-D probability than non-users, whereas Hispanic users showed a higher probability. Chewing or swallowing problems severely escalated Prb-D probability for Hispanic adults (42.2%) compared to NH Whites (19.3%), and depression doubled the overall risk of Prb-D.

The burden of cognitive decline is deeply unequal, proving standardized interventions insufficient for minority older adults. Addressing these disparities necessitates culturally responsive care pathways and the elimination of structural barriers, particularly inadequate insurance coverage for audiology and dental services.