Data Shows Racial Disparities In Alzheimers Disease Diagnosis Between Black And White Research Study Participants
Black participants in Alzheimers disease research studies were 35% less likely to be diagnosed with Alzheimers and related dementias than white participants, despite national statistics that indicate that Black Americans are overall about twice as likely to develop dementias than whites. The analysis of data on study participants from across NIAs network of Alzheimers Disease Research Centers also showed that Black participants with Alzheimers and related dementias had more risk factors for the disease, as well as greater cognitive impairment and symptom severity than white participants. Results of the study were published in the journal Alzheimers and Dementia.
Researchers, led by Keenan Walker, Ph.D., from the NIA Intramural Research Program, found that Black study participants showed higher rates of cognitive impairment, particularly on measures of processing speed, executive function, and language, compared with white participants. Black participants also had higher rates of hypertension and diabetes, potential risk factors for Alzheimers and related dementias.
Cardiovascular And Cerebrovascular Disease
Vascular factors and conditions that may be associated with cognitive decline and dementia include stroke, diabetes, hypertension, congestive heart failure, high fat intake, high cholesterol, smoking, alcohol misuse, atrial fibrillation, low folate, and obesity . Although there is no definitive evidence linking cardiovascular disease and Alzheimer’s disease, studies have found associations between cognitive impairment and cardiovascular disease .
Most of the cardiovascular disease risk factors are more common in African Americans and Hispanics . Geographic variation in the prevalence of cardiovascular disease risk factors may be related to differences in regional dietary patterns. More than 80% of Blacks aged 65+ in 2000 were born in the South, and Southern-born individuals have significantly higher rates of circulatory disease mortality .
Vascular dementia accounts for a larger proportion of cases of related dementias in African Americans than in Whites . However, as with other dementia disorders, it is unclear whether differences in the prevalence of vascular dementia reflect true differences or are a result of measurement bias because of differences in education, socioeconomic status, or other cultural factors. One recent study found that reducing ethnic and racial disparities in the incidence of Type 2 diabetes could reduce the incidence of cognitive impairment and dementia by 17% .
Varying Perceptions Of Alzheimer’s
Differing perceptions of Alzheimer’s disease among racial and ethnic groups also pose roadblocks to quality care and support, according to the report. Nearly half of whites are concerned about developing Alzheimer’s, compared to just 25 percent of Native Americans, 35 percent of Blacks, 41 percent of Hispanics and 46 percent of Asians.
The report suggests that personal experience may be influencing those varying levels of concern. Eighty percent of whites say they know someone with dementia compared to 65 percent of Blacks, 65 percent of Native Americans, 64 percent of Hispanics and 59 percent of Asians.
The report also found that a majority of Blacks, Hispanics, Asians and Native Americans view memory loss and cognitive decline as a natural part of aging rather than a sign of disease requiring medical attention. Whites were twice as likely as Hispanic, Black and Native Americans to say they would go to a doctor if they were experiencing such problems.
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Concerned About Having Alzheimers
If youre concerned about your thinking or memory, or want to establish a baseline from which to monitor your cognition, BrainTest® is the application for you. BrainTest is the same kind of screening test at doctors offices, but one thats uniquely designed to screen for early changes in cognition associated with Alzheimers Disease, Dementia, and Mild Cognitive Impairment. BrainTest can be taken in the privacy of your own home, anonymously scored at our centralized scoring core-lab, and result videos delivered inside the application feature an explanation of your score from a Board Certified Physician. When youre ready, these results can be shared with your doctor to help start the conversation if youre concerned.
Take your first BrainTest® for free today . Simply access the free app here.
Alz. . Latest Facts and Figures Report. Alzheimers Association. Retrieved from
Recruitment Of Study Cohorts
In the last decade, innovative approaches that situate disparities within the historical inequities that caused them, while at the same time celebrating cultural assets, have also been shown to be effective strategies for increasing recruitment and engagement in research studies,,,. One study blended use of technology, neighbourhood walking and social reminiscence with the aim of maintaining cognitive health in older African American individuals with and without MCI. Another study was a randomized trial within senior centres that evaluated the ability of a community choir programme called The Community of Voices to promote health and well-being. Such approaches integrated with rigorous mixed methods can reveal unique participant perspectives about barriers to and facilitators of study participation, particularly for studies that require a higher level of commitment, such as brain autopsy,.
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Ethnic Differences And Cognitive Testing
The most commonly accepted research criteria for probable or possible AD require the diagnosis to be confirmed by neuropsychological tests demonstrating impairments of performance in memory and two other cognitive domains. However, few cognitive ability measures have been properly validated for use among ethnic minorities in the United States. Lack of such validation may account for the fact that, based on neuropsychological test performance, ethnic minorities are judged to be cognitively impaired more often than non-Hispanic whites. This section will review studies within and outside the United States that have compared the cognitive test performance of different ethnic groups, and describe constructs that might allow for more sophisticated investigations of ethnic differences in the future.
Translators of cognitive measures must use extreme caution and proper methods to adapt measures into another language. describe several examples of Spanish versions of tests that include syntactic, lexical, and spelling errors. These authors also suggest that investigators consult only those who possess native fluency and indepth knowledge of the culture before attempting to translate a measure. The accuracy of translated and adapted instruments should be checked following established guidelines . Researchers and clinicians must also develop standards to determine in which language bilinguals should be assessed .
Norms
Use of Interpreters
Ways To Help Prevent Dementia
Individuals cannot change some risk factors, such as age, genetics, or socioeconomic status.
As a national community, we must take responsibility for changing the structural inequalities within healthcare that lead to missed opportunities for diagnosis, poorly funded research, and a lack of understanding of medical care.
But there are also steps individuals can take to reduce their own risk for dementia:
- Eating a healthy, balanced diet: Following the Mediterranean diet, which is rich in fish and vegetables, can lead to improved cognitive function.
- Increasing physical activity: Regular exercise and physical activity may help to reduce the risk of chronic conditions linked to dementia, such as high blood pressure, diabetes, and depression.
- Controlling blood pressure: Keeping high blood pressure under control can lower the risk of stroke and heart disease, both of which have links to dementia.
- Cognitive training: According to the
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What Stops People From Finding Out They Have Dementia
People from some cultures and ethnic groups are less likely to get a diagnosis than others. That’s because different beliefs about dementia may lead a person to not get checked if they are having trouble with their memory. They may wait to go to the doctor until the dementia is very advanced. But, there are other reasons people don’t go to the doctor, too.
For example, people in some cultures don’t even realize that memory loss is the sign of a serious problem like dementia. In other situations, family members and friends don’t pay attention to someone’s memory loss because the person looks fine. Sometimes, people with memory problems are seeing health providers who don’t speak their language, and this makes it hard to talk about concerns about memory loss and other signs of dementia.
Level Of Education Cognitive Reserve And Alzheimers Disease
AD pathology progresses before symptoms of cognitive decline appear, more specifically before they can be detected. Individuals with a lower cognitive reserve cannot endure AD pathology without developing overt symptoms as long as individuals with a higher cognitive reserve . Kim et al. explored the potential effects of education on AD pathology, diagnosis, and progression longitudinally. Participants were followed up more than three times to record their Clinical Dementia Rating scores and were placed in one of three groups, namely, subjective cognitive impairment , mild cognitive impairment , and advanced AD. They found that those with higher educational levels had slower progression from SCI to MCI than those with lower education levels . Table 1 presents details of the studies aimed at analyzing the relevance of the level of education in the diagnosis and progression of Alzheimers disease.
Table 1 Studies aimed at analyzing the relevance of level of education in the diagnosis and progression of Alzheimers disease
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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.
Dominican Republic And The Caribbean
In contrast to sporadic AD, late-onset familial AD among Caribbean Hispanics is strongly associated with APOE 4. A study of 203 Caribbean Hispanic families residing in the greater New York City area, the Dominican Republic, and Puerto Rico found that the presence of the APOE 4 allele was strongly associated with AD. In addition, 8 of the 19 families with at least 1 family member with onset of dementia before age 55 showed an association with a previously unreported presenilin mutation. The same group found modest evidence of linkage to loci on chromosome 12p among 79 Caribbean Hispanic families with AD, which varied by age at onset of AD and by the presence or absence of the APOE-4 allele.
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Comparison Of Chinese And Malay Ethnic Groups
Overall, the Malay ethnic had higher odds of having the any dementia outcome compared to the Chinese ethnic group. Combining results of two comparable prevalent outcome studies using a meta-analysis we obtained a pooled odds ratio of 2.28 with an I-squared value of 43.7% .
Forest plot: Chinese and Malay ethnic groups.
Risk of bias assessment: Chinese and Malay ethnic groups
The two cross-sectional prevalence studies had low to moderate risk of bias for most criteria .
Alzheimer’s Society’s View On Demography
The number of people with dementia is steadily increasing. We believe that careful planning is needed.
Alzheimer’s Society believes that careful planning for the future is needed now to ensure that the right care and support is available.
The report, Projections of older people with dementia and costs of dementia care in the United Kingdom, 2019-2040 , provides the most up-to-date evaluation of the numbers of people with dementia in the UK, projections on numbers of people in the future and the prevalence of dementia.
This research was conducted by the Care Policy and Evaluation Centre at the London School of Economics and Political Science on behalf of Alzheimers Society.
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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.
Cultural Beliefs About Dementia And Cognitive Decline
Social and cultural differences in the meaning of dementia and beliefs about cognitive decline among elders may play a part in the different rates of AD by ethnicity, and may also explain the lack of consensus on rates of AD across studies. Cultural values may include beliefs that dementia-related changes are part of the normal aging process rather than an abnormal process, such that in some groups and communities, cognitive decline may not elicit concern until symptoms are well beyond the early or mild stages . Differences in the meaning of cognitive decline highlight the need for community-based random samples and recruitment strategies that improve the rates of participation of ethnically diverse elders .
Individuals within some cultures may be more likely to view cognitive decline as disgraceful and something that should be kept within the family. A dementing illness may be difficult to accept when the ethnic elder may be the historian, mediator, and provider of emotional and financial support for many generations of family members living in the same home . found that although African-Caribbean elders living in London reported a larger number of family members living nearby and were more likely to live with at least one other family member, they received no more help from their families with activities of daily living, yet were more likely to have difficulties in this area.
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Quick Alzheimers Facts Within The United States
To display just how severe this condition is in terms of illnesses throughout the United States, here are some quick facts that truly display this disease which is growing in terms of its prevalence.
- Within the senior population, one out of every three individuals suffers from Alzheimers or another form of dementia.
- In the United States, Alzheimers is the sixth-leading cause of death.
- Of those directly affected by Alzheimers, two-thirds are women.
- In comparison to cancer, where 90 percent of individuals become aware of their diagnosis, only 45 percent of people with Alzheimers are told about their diagnosis.
- In 2015, Alzheimers and other forms of dementia will cost the United States $226 billion. This value is expected to increase to $1.1 trillion by 2050.
- In the United States, someone develops Alzheimers every 67 seconds.
Education And Income Levels
The Alzheimer’s Association outlined three risks that were connected with increased risk of dementia including living in rural areas, a lower education level and having a lower income level. They also found that African Americans and Hispanics were more likely to have a lower education and income level, thus placing them at increased risk for developing dementia.
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Interventions To Reduce Racial And Ethnic Disparities
Although there is extensive evidence documenting disparities among different racial and ethnic groups with Alzheimer’s disease, there are few studies evaluating interventions to address disparities in this population. Almost all interventions designed to explicitly address racial and ethnic disparities focus on cultural competency on the part of the health care provider and/or health system. Interventions not specific to the Alzheimer’s disease population include care coordination, care management, community health workers, and culturally tailored education interventions .
Cultural Competence
Cultural competency is especially important in the health care setting, where barriers to communication and access to quality care can result in delayed diagnosis, inappropriate treatment, or worse. Cultural competence involves both awareness and knowledge about other cultures and skill in relating to people of other cultures. Cultural competence requires acknowledging that culture and ethnicity guide and affect behavior, and that all people are cultural beings .
A culturally competent health care environment includes the following characteristics : a culturally diverse staff that reflects the communities served bilingual staff or interpreters for the clients’ languages culture-specific and language-specific training for providers and signs and materials in the clients’ languages that are sensitive to cultural norms.
Outreach to Minority Communities
Alzheimer’s Disease Presentation Between Different Native Languages
Studies comparing different languages and AD incidence and prevalence are scarce outside of alphabetic languages. In a study comparing English- to Chinese-speaking AD patients on a number transcoding task , Chinese-speakers had more intrusions in transcoding numbers than the English-speakers with no meaningful differences in syntactic errors, indicating that the difference is not due to differences in executive function among Chinese- and English-speaking AD patients . Overall, while comparisons in the incidence and prevalence of AD between speakers of different languages indicate important socio-ethnic influences across cultures, more research is needed to fully understand how AD presentation differs between speakers of different languages.
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Largest And Longest Study Of Ethnic Disparities In Dementia
The study population included more than 274,000 northern California members of Kaiser Permanente, the nations largest private integrated healthcare system with more than 10 million members. The researchers used electronic health records covering patient visits over 14 years from January 2000 through December 2013 to identify participants diagnosed with dementia, as well as their race and ethnicity. The dementia diagnoses were Alzheimers, vascular dementia or non-specific dementia.
Elizabeth Mayeda, PhD
“Even in the lowest risk groups in the study, the lifetime risk of developing dementia is high in every racial and ethnic group, over one in four people who survive to age 65 can expect to be diagnosed with dementia in their lifetime, said Rachel Whitmer, PhD, the principal investigator of the study and a research scientist at the Kaiser Permanente Division of Research. Whitmer has an extensive research portfolio in aging epidemiology, specifically in predictors of cognitive decline and dementia, and population-level risk factors including metabolic, cardiovascular and inflammatory factors.
This study has major public health implications. If all individuals aged 65 or older had the same rate of dementia as Asian Americans, 190,000 cases of dementia would be prevented annually, Whitmer added. These findings underscore the need to better understand risk factors for dementia throughout life to identify strategies to eliminate these inequalities.
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