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RACIAL DISPARITIES IN ALZHEIMERS DISEASE For Black/Africian Americans and Hispanic Americans

Zekel Healthcare

Posted 16th June 2019.

Current reports state that Alzheimer’s is the sixth leading cause of death for all Americans, and the fourth leading cause of death for older black/African Americans. Additionally, it notes that black/African American elders are two to three times more likely to have Alzheimer’s disease compared with whites. With evidence of this magnitude, we realize an investment to stop, prevent or cure Alzheimer’s must be accelerated. There is a clear and urgent need to promote informed decisions about health dementia-related preventive behavior in the African American community. The Emory ADRC will strengthen its capacity via educational initiatives and screening and detection efforts by developing culturally sensitive educational materials that are consistent with several objectives of the National Alzheimer’s Project Act (NAPA) signed into law by President Obama. Over the years we have used established and innovative strategies to provide information and education regarding early detection and diagnosis issues related to caregiving, and developments in research to reduce racial disparities by:

Disseminating information to the community about risk factors for cognitive impairment that include how to identify early warning signs of memory loss.
Offering cognitive screening opportunities to facilitate the diagnosis of disorders that impair thinking.
Providing continuing education hours for nurses, social workers and allied health care professionals.
Through internal and external support the Emory ADRC has gained traction and momentum to effect changes in knowledge, attitudes, and behaviors so that individuals become proactive and informed consumers regarding their cognitive health.

As the US elderly population continues to expand rapidly, Alzheimer’s disease poses a major and increasing public health challenge, and older African Americans may be disproportionately burdened by the disease. Although African Americans were generally underincluded in previous research studies, new and growing evidence suggests that they may be at increased risk of the disease and that they differ from the non-Hispanic white population in risk factors and disease manifestation. This article offers an overview of the challenges of Alzheimer’s disease in African Americans, including diagnosis issues, disparities in risk factors and clinical presentation of disease, and community-based recommendations to enhance research with this population. Racial and ethnic differences in the prevalence of Alzheimer’s and other dementias. Although there are more non-Hispanic whites living with Alzheimer’s and other dementias than any other racial or ethnic group in the United States, older black/African Americans and Hispanics are more likely, on a per-capita basis, than older whites to have Alzheimer’s or other dementias. Most studies indicate that older black/African Americans are about twice as likely to have Alzheimer’s or other dementias as older whites. Some studies indicate Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites. Recent studies suggest the increased likelihood for Hispanics may be slightly lower than this, depending upon the specific Hispanic ethnic group observed (for example, Mexican Americans compared with Caribbean Americans).

The higher prevalence of Alzheimer’s dementia in minorities compared with whites appears to be due to a higher incidence of dementia in these groups. Variations in health, lifestyle and socioeconomic risk factors across racial groups likely account for most of the differences in risk of Alzheimer’s and other dementias. Despite some evidence that the influence of genetic risk factors on Alzheimer’s and other dementias may differ by race, genetic factors do not appear to account for the large differences in prevalence or incidence among racial groups. Instead, health conditions such as cardiovascular disease and diabetes, which are associated with an increased risk for Alzheimer’s and other dementias, are believed to account for these differences, as they are more prevalent in black/African-American and Hispanic people. Socioeconomic characteristics, including lower levels of education, higher rates of poverty, and greater exposure to adversity and discrimination, may also increase risk in black/African-American and Hispanic communities. Some studies suggest that differences based on race and ethnicity do not persist in rigorous analyses that account for such factors. There is evidence that missed diagnoses of Alzheimer’s and other dementias are more common among older black/African Americans and Hispanics than among older whites. Based on data for Medicare beneficiaries age 65 and older, Alzheimer’s or another dementia had been diagnosed in 10.3 percent of whites, 12.2 percent of Hispanics, and 13.8 percent of black/African Americans. Although rates of diagnosis were higher among black/African Americans than among whites, according to prevalence studies that detect all people who have dementia irrespective of their use of the health care system, the rates should be even higher for black/African Americans.

There are fewer data from population-based cohort studies regarding the national prevalence of Alzheimer’s and other dementias in racial and ethnic groups other than whites, black/African Americans, and Hispanics. However, a study examining electronic medical records of members of a large health plan in California indicated that dementia incidence determined by the presence of a dementia diagnosis in members’ medical records was highest in black/African Americans, intermediate for Latinos (the term used in the study for those who self-reported as Latino or Hispanic) and whites, and lowest for Asian Americans. A follow-up study with the same cohort showed heterogeneity within Asian-American subgroups, but all subgroups studied had lower dementia incidence than whites. A recent systematic review of the literature found that Japanese Americans were the only Asian-American subgroup with reliable prevalence data, and that they had the lowest prevalence of dementia compared with all other ethnic groups. Alzheimer’s disease continues to be a large and growing public health problem for caregivers and families, health services workers, and policy makers. Occurrence of the disease is strongly related to age, and because the population ages sixty-five and older is growing at a rapid pace, the number of people with dementia is expected to increase significantly in the coming decades. At the same time, the United States is becoming increasingly diverse, particularly among the elderly. In 2010 the US Census Bureau indicated that 20 percent of the US population ages sixty-five and older was a racial or ethnic minority. Current projections suggest that by 2050, 42 percent of the nation’s older adults will be members of minority groups. Among those ages eighty-five and older, 33 percent are projected to be a minority.

This demographic shift in both age and racial composition will represent a critical challenge to minority populations, particularly older African Americans, because a growing body of evidence suggests that black/African Americans may have a greater risk of Alzheimer’s disease compared to the non-Hispanic white population. Yet knowledge about diagnosis, mechanisms, management, and treatment of the disease is based almost exclusively on studies of non-Hispanic whites. The lack of high-quality biologic data on large numbers of racial and ethnic minorities poses critical barriers to progress in understanding whether the mechanisms and processes of Alzheimer’s disease operate the same or differently in racial and ethnic minorities and, if so, how, particularly in the high-risk African American population. In this brief overview of racial disparities in Alzheimer’s is followed by a review of the evidence for disparities in risk factors for clinical manifestations of the disease, recommendations for future directions to expand understanding of Alzheimer’s in the African American population, and strategies to guide research efforts in this area. It is important to note that this review highlights primarily biologic mechanisms underlying health disparities because Alzheimer’s disease is a neurodegenerative disease. We do not mean to suggest that biologic differences alone account for disparities in Alzheimer’s disease. There is a large and diverse literature on cultural beliefs and perceptions of disease and aging, inequities in health care access, life-course influences, and social and cultural variations in caregiving experiences, 1,2 and these factors likely intersect with biologic mechanisms in currently unknown ways, resulting in these health disparities for Alzheimer’s disease. A comprehensive review of these nonbiologic issues is beyond the scope of this article. However, given the complexity of the disease and the fact that no single factor has accounted for observed disparities, multi-interdisciplinary collaborations that can integrate multidimensional layers of data (such as biologic, social, life course, environmental, and policy) will be necessary to move the field forward and address one of the most urgent public health problems of our time.

Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles). These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body. Solomon Carter Fuller, M.D., was one of the first known black psychiatrists and worked alongside Dr. Alois Alzheimer. Alzheimer’s is the sixth leading cause of death in the country and it’s estimated that every 66 seconds someone develops the disease in the United States, according to the Alzheimers Association. More than five million Americans currently have Alzheimer’s and that figure is expected to jump as high as 16 million by 2050. But not all Americans have the same risk level nearly two-thirds of those with Alzheimer’s are women, according to the Alzheimer’s Association. And black Americans twice as likely as their white counterparts to develop Alzheimer’s and dementia. Alzheimer’s disease continues to be a large and growing public health problem for caregivers and families, health services workers, and policy makers. Occurrence of the disease is strongly related to age, and because the population ages sixty-five and older is growing at a rapid pace, the number of people with dementia is expected to increase significantly in the coming decades. At the same time, the United States is becoming increasingly diverse, particularly among the elderly. Alzheimer’s disease for genetic, biological and socioeconomic reasons. Diet and even the stress of experiencing racism can be factors. Yet relatively few African Americans want to talk about Alzheimer’s, which is the leading cause of dementia. For historical reasons, even fewer want to participate in clinical research trials that could deliver benefits to themselves and future generations.

Talk to your healthcare provider about local studies that may be right for you.
Contact Alzheimer’s disease research centers or memory or neurology clinics in your community.

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About Zekel Healthcare, Mauris Griffin founder ZEHE (Healthcare) The Company, healthcare IT eco system research in Alzheimer’s is a disease of the brain that causes problems with memory, thinking and behavior. Alzheimer’s is the sixth-leading cause of death in the United States, and today of the 5.4 million Americans are living with the disease. Every 69 seconds, someone in America develops Alzheimer’s disease, and by mid-century someone will develop Alzheimer’s every 33 seconds. Listen to our podcasts AlzheimersQ, AlzheimersIQ, DementiaQ FibonC Element in English and Spanish on Apple Podcast, Google Podcast, Spotify, Tunein, Stitcher or on EKG Apple Watch Series 4.

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