Differences In Imaging Orders Between Clinics
To determine if racial differences in the clinics where patients are evaluated could contribute to the observed underutilization of AD-related PET imaging in African Americans, we compared orders for these imaging studies across the various outpatient settings to the enterprise-wide rates . As expected, AD-related PET imaging was much more likely to be ordered by Memory Disorders providers than by providers in any other outpatient setting. Amyloid-PET was ordered exclusively in the Memory Disorders clinic and FDG-PET was also ordered more commonly in the Memory Disorders clinic compared to the Other Neurology, Primary Medicine, and Geriatrics clinics . Since Memory Disorders clinic providers were more likely to order AD-related PET imaging, the fact that African Americans were less frequently seen in this clinic is a potential reason that they were less likely, at an enterprise-wide level, to have these tests.
Neuroimaging for Alzheimers disease and mild cognitive impairment outpatients by race and clinic
No Differences In Insurance Coverage
Finally, we examined whether there were differences in insurance coverage that could contribute to the observed differences in encounter patterns, neuroimaging, and medication usage. However, the African American proportion of AD/MCI outpatients with encounters covered by federally funded or commercial insurance programs was not statistically different from the non-Hispanic white proportion, both enterprise-wide and within each outpatient clinical setting . Regardless of race, nearly all AD/MCI outpatients had at least some level of coverage, with over 90% having insurance pay for a given encounter which was not different between clinics. Procedurally, insurance coverage is not a motivating factor for any specialty clinic nor primary settings at this institution none of the clinics screen patient referrals according to insurance type and all clinics have financial assistance programs. Taken together, these results suggest the reason these patients are being seen by primary providers instead of specialists is not because of a difference in coverage.
Insurance coverage use by clinic setting
Possible Reasons For Racial And Ethnic Disparities
Possible reasons for racial and ethnic disparities include factors related to measurement of Alzheimer’s disease, genetics, cardiovascular and cerebrovascular disease, socioeconomic factors, cultural differences, and racial and ethnic discrimination. A range of pathways have been suggested that link race and ethnicity with cognitive impairment, some of which have implications for disparities . In this section, we describe the evidence underlying selected factors, mediators, and pathways associated with disparities in this population.
FIGURE 3. Pathways Linking Race/Ethnicity and Cognitive Impairment
: Adapted from Glymour and Manly, 2008.
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Prevalence Of Scd Among Racial/ethnic Groups By Selected Characteristics
During 20152018, 10.8% of adults aged 45years or older reported SCD. The prevalence of SCD varied by race and ethnicity. SCD was reported by 10.7% Whites, 12.3% Blacks and 9.9% Hispanics . Across groups defined by race and ethnicity, higher percentages of adults with SCD had at least one comorbid chronic condition compared to those without SCD. More than 3 in 4 Blacks with SCD had at least one chronic condition compared to 60.9% without SCD . Among whites with SCD nearly 64% had at least one chronic condition as compared to less than half of whites without SCD . 64.1% Hispanics with SCD reported at least one chronic condition as compared to 55.5% without SCD .
Table 1 Demographic Characteristics of Adults Aged 45Years or Older With and Without Subjective Cognitive Decline by selected Race/Ethnic Status, Behavioral Risk Factor Surveillance System , 20152018
Outreach To Minority Communities
Another approach to addressing disparities involves targeting programs and outreach to minority populations. For example, the Alzheimer’s Disease Demonstration Grants to States program provided demonstration grants to Florida, Kentucky, and the District of Columbia, that focused on African Americans . For example, in the District of Columbia, the intervention focused on educational efforts conducted within church communities. They also held awareness events and developed caregiver respite programs. More recently, several of the current Alzheimer’s Disease Supportive Services Program grantees, including South Carolina, California, Florida, North Carolina and Puerto Rico, are targeting ethnic or racial groups.
Another intervention aimed at reaching minority populations is the Alzheimer’s Disease Research Center Satellite Diagnostic and Treatment Clinics program . Begun in 1990, the program established satellite clinics linked with one of the 30 existing Alzheimer’s Disease Centers. In recent years, satellite clinics have been established on the Choctaw nation reservation, in Harlem, at Grady Hospital in Atlanta, and in St. Louis. The Alzheimer’s Disease Centers are actively involved in formulating strategies and plans to recruit diverse populations to their clinics. Strategies that have met success include improved patient coordination, increasing the personal attention patients receive, home visits, and support groups .
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What Causes Alzheimers Disease
In recent years, scientists have made tremendous progress in better understanding Alzheimers and the momentum continues to grow. Still, scientists dont yet fully understand what causes Alzheimers disease in most people. In people with early-onset Alzheimers, a genetic mutation may be the cause. Late-onset Alzheimers arises from a complex series of brain changes that may occur over decades. The causes probably include a combination of genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimers may differ from person to person.
Racial Ethnic Disparities Occur In Recruitment For Preclinical Alzheimers Disease Trial
Raman R, et al. JAMA Network Open. 2021 doi:10.1001/jamanetworkopen.2021.14364.
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Differences in sources of recruitment, reasons for screen failure and overall probability of eligibility occurred across racial/ethnic groups included in a large preclinical Alzheimers disease trial conducted in North America.
Researchers published results on the racial and ethnic differences observed in the trial in JAMA Network Open.
Preclinical AD trials face difficulty in recruiting diverse participants, perhaps in part due to unique challenges in these novel studies,Rema Raman, PhD, professor of neurology at the University of Southern Californias Keck School of Medicine and director of biostatistics at the USC Alzheimers Therapeutic Research Institute, University of Southern California, and colleagues wrote. We examined the sources of recruitment and the reasons for screen failure among underrepresented racial and ethnic group participants in the first preclinical AD trial, the Anti-Amyloid treatment in Asymptomatic Alzheimer study.
Recruitment sources, study eligibility and ineligibility reasons served as the studys primary outcomes. The researchers conducted regression analyses for the likelihood of being eligible after the first screening visit involving clinical and cognitive assessments to evaluate the probability of trial eligibility.
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Rural Versus Urban Analysis
The United States Department of Agriculture’s rural-urban continuum classification system defines rurality by absolute population and classifies each county in the US by degree of rurality in a rank order fashion using a nine-tier scale from a population of less than 2,500 to a population of greater than 1 million. This system separately classifies less populated areas which are adjacent to large urban areas, such as suburbs.
To determine the relationship between rurality and Parkinson disease, we applied the rural-urban continuum classification system to county level age and race standardization for Parkinson disease prevalence and incidence from the year 2002. We compared the mean prevalence and incidence across these categories of rurality using a Kruskal-Wallis test. The prevalence and incidence for the most rural counties were also compared to those of the most urban counties with a two-tailed t test.
Grand Prix ‘more Than A Race’
The Spina Bifida of Jacksonville team finished 19th. The rookie team might not have taken the checkered flag, but the event nonetheless was a victory for the racers and those they represented in the event.
This year’s public awareness and fundraising campaign “Love what drives you” connects the racers to the spina bifida wheelchair users, Demery Webber, executive director of Spina Bifida of Jacksonville, said between cheering on the organization’s racing team.
Spina Bifida is the most common permanently disabling birth defect in the United States. An average of eight babies a day are born with spina bifida or a similar birth defect of the brain and spine, Webber said.
The Jacksonville Grand Prix is more than just a kart race. It was established 19 years ago in honor of Webber’s daughter, Lindsey now 21 who has spina bifida, her mother said.
Many people with spina bifida spend time at the kart track, so there is a “wheel-to-wheel” connection and parallel with the go-kart racers, Webber said.
“The racers get to come out and have a great day riding around and helping us advocate and serve our spina bifida community,” she said.
The organization’s race team was composed of parents of children with spina bifida, a child of an adult with spina bifida and also a brother of a younger brother who has spina bifida, Webber said.
Although the team finished back in the pack, the event was memorable for the “spina bifida family,” she said.
How Is Alzheimers Disease Treated
Alzheimers is complex, and it is therefore unlikely that any one drug or other intervention will successfully treat it in all people living with the disease.
Scientists are exploring many avenues to delay or prevent the disease as well as to treat its symptoms. In ongoing clinical trials, scientists are developing and testing several possible interventions. Under study are drug therapies aimed at a variety of disease interventions, as well as nondrug approaches such as physical activity, diet, cognitive training, and combinations of these. Just as we have many treatments for heart disease and cancer, we will likely need many options for treating Alzheimers. Precision medicine getting the right treatment to the right person at the right time will likely play a major role.
Current approaches to treating Alzheimers focus on helping people maintain mental function, treating the underlying disease process, and managing behavioral symptoms.
For More Information About Genetic Disorders That Are More Common In Certain Groups:
The Norton & Elaine Sarnoff Center for Jewish Genetics provides information on disorders that occur more frequently in people with Jewish ancestry, including genetic traits that tend to be more common in Ashkenazi Jews and .
The Centers of Disease Control and Prevention provides data on the prevalence of sickle cell disease in various populations in the United States.
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Does Heart Health Play A Role In Dementia Risk
We know that what is good for the heart is good for the head. Improving heart health seems to be a good way to lower dementia risk. The health of a heart affecting dementia risk might also be linked to sex. For example, high blood pressure in midlife is believed to increase risk in women but not men, even though it is more common in men.
Professor Patrick Kehoe is an Alzheimers Society funded researcher based at University of Bristol. He says:
‘It is possible that the complex relationship of oestrogen to the renin angiotensin system, which regulates blood pressure and has roles in cognitive function, influences a womans risk of developing Alzheimers. Following menopause with the influence of oestrogen on this system a woman is at greater risk of high blood pressure and so perhaps also dementia, but we need to test this in more detail.
Facts About Women And Dementia
- More women are affected by dementia than men. Worldwide, women with dementia outnumber men 2 to 1.
- Brain scans tell us that the rate at which brain cells are dying in the brain is faster in women than in men.
- Women are more likely to live longer than men. However, although risk increases with age, dementia is caused by diseases of the brain not age alone.
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Incidence Across Race And Ethnicty
Several studies have found that PD is more common in Whites than in Blacks or Asians. It is estimated that the prevalence of PD is 50 percent lower in Blacks and Asians than in Whites.5,6
However, the highest incidence of PD is found in Hispanics, followed by non-Hispanic Whites, Asians, and Blacks. According to one older study, the incidence of PD in Hispanics is 16.6 per 100,000 persons, compared to 13.6 per 100,000 in non-Hispanic Whites, 11.3 per 100,000 in Asians, and 10.2 per 100,000 in Blacks.5,6
Urban areas have a higher prevalence and incidence of PD.5
Exposure To Possible Protective Factors
Nonwhite and Hispanic women are less likely to receive counseling about estrogen replacement therapy from their physician and less aware of its health benefits . Access to and utilization of health care is significantly lower among ethnic minorities than among whites in the United States. Therefore, there may be less exposure to possible protective factors for AD, including estrogen replacement therapy and antiinflammatory drugs. Ethnic differences in diet and vitamin intake may reduce exposure to antioxidants, which may also protect the brain from AD pathology.
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Race May Affect Alzheimer’s Survival
Study Shows Latinos and African-Americans With Alzheimer’s Disease Live Longer Than Whites
The findings from a study involving nearly 31,000 patients treated at more than 30 Alzheimer’s centers across the country revealed that, compared with whites, Latinos were 40% and African-Americans were 15% less likely to die during the study period.
The ethnic differences were seen even after researchers accounted for other factors known to influence survival, including education level and age at symptom onset.
Researcher Kala Mehta, DSc, who is an epidemiologist at the University of California, San Francisco, says she went into the study expecting to find that whites live longer than the other ethnic groups studied following an Alzheimer’s diagnosis.
“That was our original hypothesis, but it wasn’t what we found,” she tells WebMD.
Differing Views Of Dementia From Blacks Hispanics Whites Asians And Native Americans
by Peter Urban, AARP, March 5, 2021
En español | For the estimated 6 million older Americans living with Alzheimer’s disease, race and ethnicity are a barrier to quality medical care, according to a new report from the Alzheimer’s Association.
The special report on Race, Ethnicity and Alzheimer’s in America found that 66 percent of Black Americans believe it would be hard for them to get what they perceive as excellent care for the brain disease. That view was shared by 40 percent of Native Americans, 39 percent of Hispanics and 34 percent of Asian Americans. All were also likely to distrust medical research and unlikely to believe health care professionals empathize with them.
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Racial And Ethnic Discrimination
Although discrimination by providers against racial and ethnic minorities in the United States is commonly asserted as the cause of racial and ethnic disparities, we were unable to find any empirical studies on this topic that focused on people with Alzheimer’s disease. Indeed, there appear to be few empirical studies on this topic in health care.
A rare study of discrimination in health care used the implicit association test to assess the degree to which implicit racial bias affected physicians’ decisions on thrombosis . A total of 287 internal and emergency medicine residents from four hospitals in Boston and Atlanta participated in an online study. Half of the physicians received information about a White patient, and the other half received the same information but were told that the patient was African American. Although physicians self-reported that they did not prefer treating one group or the other and did not see either group as more cooperative, the test found a preference for treating Whites and the perception that African Americans were less cooperative. Similarly, Blanchard and Lurie found that minorities were more likely to report being looked down upon or treated with disrespect than Whites. Specifically, adjusting for sex, language, income, insurance coverage, and education, 20% of Asians, 19% of Hispanics, and 14% of Blacks reporting being treated disrespectfully or looked down upon by their provider compared to 9% of Whites.
The Basics Of Alzheimers Disease
Scientists are conducting studies to learn more about plaques, tangles, and other biological features of Alzheimers disease. Advances in brain imaging techniques allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Scientists are also exploring the very earliest steps in the disease process by studying changes in the brain and body fluids that can be detected years before Alzheimers symptoms appear. Findings from these studies will help in understanding the causes of Alzheimers and make diagnosis easier.
One of the great mysteries of Alzheimers disease is why it largely affects older adults. Research on normal brain aging is exploring this question. For example, scientists are learning how age-related changes in the brain may harm neurons and affect other types of brain cells to contribute to Alzheimers damage. These age-related changes include atrophy of certain parts of the brain, inflammation, blood vessel damage, production of unstable molecules called free radicals, and mitochondrial dysfunction .
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Barriers To Quality Care
Regardless of race or ethnicity, survey respondents see affordability as the most likely barrier to excellent care and support for Alzheimer’s or dementia ranging from 70 percent of Asians to 52 percent of Blacks. To a lesser extent, Americans also see lack of health insurance coverage, services missing in their community, and a lack of family and community support as likely barriers.
Blacks, however, were most likely to perceive racial and ethnic discrimination as a barrier to receiving quality Alzheimer’s care, with 36 percent saying so, compared to 19 percent of Asians, 18 percent of Hispanics, 12 percent of Native Americans and just 1 percent of whites.
A significant concern among racial and ethnic groups is a perceived lack of empathy from health care providers. Just 48 percent of Blacks feel confident they have access to providers who understand their ethnic or racial background and experiences. That compares with 47 percent of Native Americans, 49 percent of Hispanics and 63 percent of Asian Americans.