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Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024; 32:773-786. [PMID: 38336573 PMCID: PMC11162952 DOI: 10.1016/j.jagp.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
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Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
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Hill-Jarrett TG, Choi M, Buto PT, Miramontes S, Thomas MD, Yang Y, Kim MH, Sims KD, Glymour MM. Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing. Neurology 2024; 102:e208005. [PMID: 38266219 DOI: 10.1212/wnl.0000000000208005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Rapid developments in Alzheimer disease (AD) biomarker research suggest that predictive testing may become widely available. To ensure equal access to AD predictive testing, it is important to understand factors that affect testing interest. Discrimination may influence attitudes toward AD testing, particularly among racially and ethnically minoritized populations, because of structural racism in health care systems. This study examined whether everyday or lifetime discrimination experiences shape interest in AD predictive testing. METHODS In the 2010 and 2012 biennial Health and Retirement Study waves, respondents were randomly selected to complete questions on interest in receiving free testing that could determine whether they would develop AD in the future. The exposures were everyday discrimination (6 items) and lifetime discrimination (7 items); both were transformed into a binary variable. Logistic regression models predicting interest in AD testing were controlled for deciles of propensity scores for each discrimination measure. Odds ratios were re-expressed as risk differences (RDs). RESULTS Our analytic sample included 1,499 respondents. The mean age was 67 (SD = 10.2) years, 57.4% were women, 65.7% were White, and 80% endorsed interest in AD predictive testing. Most of the participants (54.7%) experienced everyday discrimination in at least one domain; 24.1% experienced major lifetime discrimination in at least one domain. Those interested in predictive testing were younger (66 vs 70 years) and more likely to be Black (20% vs 15%) or Latinx (14% vs 8%) than participants uninterested in testing. The probability of wanting an AD test was not associated with discrimination for Black (RD everyday discrimination = -0.026; 95% CI [-0.081 to 0.029]; RD lifetime discrimination = -0.012; 95% CI [-0.085 to 0.063]) or Latinx (RD everyday discrimination = -0.023, 95% CI [-0.082 to 0.039]; RD lifetime discrimination = -0.011; 95% CI [-0.087 to 0.064]) participants. DISCUSSION Despite historical and contemporary experiences of discrimination, Black and Latinx individuals express interest in AD testing. However, Black and Latinx individuals remain underrepresented in AD research, including research on AD testing. Interest in personalized information about dementia risk may be a pathway to enhance their inclusion in research and clinical trials.
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Affiliation(s)
- Tanisha G Hill-Jarrett
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Minhyuk Choi
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Peter T Buto
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Silvia Miramontes
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Marilyn D Thomas
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Yulin Yang
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Min Hee Kim
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Kendra D Sims
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - M Maria Glymour
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
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Rawat P, Sehar U, Bisht J, Reddy AP, Reddy PH. Alzheimer's disease and Alzheimer's disease-related dementias in Hispanics: Identifying influential factors and supporting caregivers. Ageing Res Rev 2024; 93:102178. [PMID: 38154509 PMCID: PMC10807242 DOI: 10.1016/j.arr.2023.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD) are the primary public health concerns in the United States and around the globe. AD/ADRD are irreversible mental illnesses that primarily impair memory and thought processes and may lead to cognitive decline among older individuals. The prevalence of AD/ADRD is higher in Native Americans, followed by African Americans and Hispanics. Increasing evidence suggests that Hispanics are the fastest-growing ethnic population in the USA and worldwide. Hispanics develop clinical symptoms of AD/ADRD and other comorbidities nearly seven years earlier than non-Hispanic whites. The consequences of AD/ADRD can be challenging for patients, their families, and caregivers. There is a significant increase in the burden of illness, primarily affecting Hispanic/Latino families. This is partly due to their strong sense of duty towards family, and it is exacerbated by the inadequacy of healthcare and community services that are culturally and linguistically suitable and responsive to their needs. With an increasing age population, low socioeconomic status, low education, high genetic predisposition to age-related conditions, unique cultural habits, and social behaviors, Hispanic Americans face a higher risk of AD/ADRD than other racial/ethnic groups. Our article highlights the status of Hispanic older adults with AD/ADRD. We also discussed the intervention to improve the quality of life in Hispanic caregivers.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA
| | - Jasbir Bisht
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Arubala P Reddy
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Scalco R, Saito N, Beckett L, Nguyen ML, Huie E, Wang HP, Flaherty DA, Honig LS, DeCarli C, Rissman RA, Teich AF, Jin LW, Dugger BN. The neuropathological landscape of Hispanic and non-Hispanic White decedents with Alzheimer disease. Acta Neuropathol Commun 2023; 11:105. [PMID: 37386610 PMCID: PMC10311731 DOI: 10.1186/s40478-023-01574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/30/2023] [Indexed: 07/01/2023] Open
Abstract
Despite the increasing demographic diversity of the United States' aging population, there remain significant gaps in post-mortem research investigating the ethnoracial heterogeneity in the neuropathological landscape of Alzheimer Disease (AD). Most autopsy-based studies have focused on cohorts of non-Hispanic White decedents (NHWD), with few studies including Hispanic decedents (HD). We aimed to characterize the neuropathologic landscape of AD in NHWD (n = 185) and HD (n = 92) evaluated in research programs across three institutions: University of California San Diego, University of California Davis, and Columbia University. Only persons with a neuropathologic diagnosis of intermediate/high AD determined by NIA Reagan and/or NIA-AA criteria were included. A frequency-balanced random sample without replacement was drawn from the NHWD group using a 2:1 age and sex matching scheme with HD. Four brain areas were evaluated: posterior hippocampus, frontal, temporal, and parietal cortices. Sections were stained with antibodies against Aβ (4G8) and phosphorylated tau (AT8). We compared the distribution and semi-quantitative densities for neurofibrillary tangles (NFTs), neuropil threads, core, diffuse, and neuritic plaques. All evaluations were conducted by an expert blinded to demographics and group status. Wilcoxon's two-sample test revealed higher levels of neuritic plaques in the frontal cortex (p = 0.02) and neuropil threads (p = 0.02) in HD, and higher levels of cored plaques in the temporal cortex in NHWD (p = 0.02). Results from ordinal logistic regression controlling for age, sex, and site of origin were similar. In other evaluated brain regions, semi-quantitative scores of plaques, tangles, and threads did not differ statistically between groups. Our results demonstrate HD may be disproportionately burdened by AD-related pathologies in select anatomic regions, particularly tau deposits. Further research is warranted to understand the contributions of demographic, genetic, and environmental factors to heterogeneous pathological presentations.
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Affiliation(s)
- Rebeca Scalco
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Laurel Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - My-Le Nguyen
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Emily Huie
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Hsin-Pei Wang
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Delaney A Flaherty
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Lawrence S Honig
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Charles DeCarli
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Andrew F Teich
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
- Taub Institute for Research On Alzheimer's Disease and Aging Brain, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Lee-Way Jin
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, 4645 2Nd Ave, 3400A Research Building III, Sacramento, CA, 95817, USA.
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Blinka MD, Gundavarpu S, Baker D, Thorpe RJ, Gallo JJ, Samus QM, Amjad H. "At least we finally found out what it was": Dementia diagnosis in minoritized populations. J Am Geriatr Soc 2023; 71:1952-1962. [PMID: 36914987 PMCID: PMC10258149 DOI: 10.1111/jgs.18329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Disparities in diagnosis persist among persons living with dementia (PLWD); most research on delayed diagnosis relies on medical records or administrative claims. This study aimed to identify factors that delay or facilitate dementia diagnoses in racial or ethnic minoritized PLWD and elicit care partner perspectives on timing and effects of diagnosis. METHODS Maryland-based participants cared for a PLWD age 60 or older, self-identified as Black/African/African-American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in-depth, semi-structured interviews were conducted and analyzed using conventional qualitative content analysis methods. RESULTS Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding dementia influenced recognition and discussion of dementia among families and communities. Diagnoses were family-initiated and started in primary care. Care partners were divided in their perceptions of diagnosis timeliness and whether earlier diagnosis would have changed outcomes. Family reactions to dementia diagnoses varied; most participants expressed a strong sentiment of service and duty to care for older family members. Participants overwhelmingly felt the benefits of obtaining a dementia diagnosis outweighed harms. CONCLUSIONS Numerous factors affect dementia diagnosis in racial and ethnic minoritized PLWD. Normalization of brain health discussions and systematic, proactive discussion and detection of dementia in primary care may address multilevel barriers and facilitators to diagnosis. Systems-level and community-led public health interventions may also help address disparities in brain health education and dementia diagnosis.
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Affiliation(s)
- Marcela D. Blinka
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sneha Gundavarpu
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Dorcas Baker
- Center for Infectious Disease and Nursing Innovation (CIDNI), Regional Partner, MidAtlantic AIDS Education and Training Center (AETC), Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Roland J. Thorpe
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph J. Gallo
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland USA
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Quincy M. Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Woldemariam SR, Tang AS, Oskotsky TT, Yaffe K, Sirota M. Similarities and differences in Alzheimer's dementia comorbidities in racialized populations identified from electronic medical records. COMMUNICATIONS MEDICINE 2023; 3:50. [PMID: 37031271 PMCID: PMC10082816 DOI: 10.1038/s43856-023-00280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/24/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Alzheimer's dementia (AD) is a neurodegenerative disease that is disproportionately prevalent in racially marginalized individuals. However, due to research underrepresentation, the spectrum of AD-associated comorbidities that increase AD risk or suggest AD treatment disparities in these individuals is not completely understood. We leveraged electronic medical records (EMR) to explore AD-associated comorbidities and disease networks in racialized individuals identified as Asian, Non-Latine Black, Latine, or Non-Latine White. METHODS We performed low-dimensional embedding, differential analysis, and disease network-based analyses of 5664 patients with AD and 11,328 demographically matched controls across two EMR systems and five medical centers, with equal representation of Asian-, Non-Latine Black-, Latine-, and Non-Latine White-identified individuals. For low-dimensional embedding and disease network comparisons, Mann-Whitney U tests or Kruskal-Wallis tests followed by Dunn's tests were used to compare categories. Fisher's exact or chi-squared tests were used for differential analysis. Spearman's rank correlation coefficients were used to compare results between the two EMR systems. RESULTS Here we show that primarily established AD-associated comorbidities, such as essential hypertension and major depressive disorder, are generally similar across racialized populations. However, a few comorbidities, including respiratory diseases, may be significantly associated with AD in Black- and Latine- identified individuals. CONCLUSIONS Our study revealed similarities and differences in AD-associated comorbidities and disease networks between racialized populations. Our approach could be a starting point for hypothesis-driven studies that can further explore the relationship between these comorbidities and AD in racialized populations, potentially identifying interventions that can reduce AD health disparities.
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Affiliation(s)
- Sarah R Woldemariam
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
| | - Alice S Tang
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tomiko T Oskotsky
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA.
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
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Burgdorf JG, Amjad H. Impact of diagnosed (vs undiagnosed) dementia on family caregiving experiences. J Am Geriatr Soc 2023; 71:1236-1242. [PMID: 36427288 PMCID: PMC10089946 DOI: 10.1111/jgs.18155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most older adults with Alzheimer's disease and related dementias (ADRD) do not receive a timely formal diagnosis, although formal diagnosis is linked to improved outcomes. Little is known about how a recognized formal diagnosis impacts family caregivers, who provide crucial support for older adults experiencing ADRD. METHODS We analyzed 2017 National Health and Aging Trends Study and linked National Study of Caregiving data for a nationally representative sample of 724 (weighted n = 5,431,551) caregivers who assisted an older adult with probable dementia. Probable dementia was determined via previously validated composite measure. We modeled caregiver experiences as a function of recognized formal ADRD diagnosis using weighted, logistic regression and adjusting for the relevant older adult and caregiver characteristics. RESULTS Among caregivers who assisted an older adult with probable dementia, those assisting an individual with recognized formal ADRD diagnosis were significantly more likely to report emotional difficulty (aOR: 1.77; p = 0.03) and family disagreement over the older adult's care (aOR: 5.53; p = 0.03). They were also more likely to assist with communication during doctors' visits (aOR: 9.71; p < 0.001) and to receive caregiving-related training (aOR: 2.59; p = 0.01). CONCLUSIONS While a timely ADRD diagnosis may help ensure access to needed supports for older adult and caregiver alike, diagnosis must be linked to support as they navigate resultant complex emotions. Formal diagnosis is linked to caregiver integration with, and support from, the older adult's team of health care providers; therefore, reducing existing disparities in timely diagnosis is necessary to ensure all caregivers have equal access to support.
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Affiliation(s)
- Julia G Burgdorf
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Huie EZ, Escudero A, Saito N, Harvey D, Nguyen ML, Lucot KL, LaGrande J, Mungas D, DeCarli C, Lamar M, Schneider JA, Kapasi A, Rissman RA, Teich AF, Dugger BN. TDP-43 Pathology in the Setting of Intermediate and High Alzheimer's Disease Neuropathologic Changes: A Preliminary Evaluation Across Ethnoracial Groups. J Alzheimers Dis 2023; 91:1291-1301. [PMID: 36617779 PMCID: PMC9974776 DOI: 10.3233/jad-220558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transactive Response DNA Binding Protein 43 kDa (TDP-43) pathology is frequently found in cases with Alzheimer's disease (AD). TDP-43 pathology is associated with hippocampal atrophy and greater AD severity denoted by cognition and clinical representation. Current TDP-43 pathology studies are predominantly based on non-Hispanic White cohorts. OBJECTIVE We sought to evaluate the presence of TDP-43 pathology across ethnoracial groups utilizing the National Alzheimer's Coordinating Center; a database containing data from over 29 institutions across the United States. Cases (N = 1135: Hispanics/Latinos = 29, African Americans/Black Americans = 51, Asians/Asian Americans = 10, American Indians/Alaskan Natives = 2, non-Hispanic White = 1043) with intermediate/high AD having data on TDP-43 pathology in the amygdala, hippocampus, entorhinal cortex, and neocortex were included. METHODS TDP-43 pathology frequency in each neuroanatomic region among ethnoracial groups were compared using generalized linear mixed effects models with center as a random effect adjusting for age at death, education, and gender. RESULTS Although groups were imbalanced, there was no significant difference across ethnoracial groups based on TDP-43 pathology (p = 0.84). With respect to neuroanatomical regions evaluated, there were no significant differences across ethnoracial groups (p-values > 0.06). There were also no significant differences for age at death and gender ratios across ethnoracial groups based on TDP-43 pathology. Although not statistically significant, TDP-43 pathology was present less often in Hispanic/Latinos (34%) when compared to non-Hispanic Whites (46%). CONCLUSION While this is a preliminary evaluation, it highlights the need for diverse cohorts and on TDP-43 pathology research across ethnoracial groups. This is the first study to our knowledge having a focus on the neuroanatomical distribution of TDP-43 deposits in Hispanic/Latino decedents with AD.
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Affiliation(s)
- Emily Z. Huie
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Anthony Escudero
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - My-Le Nguyen
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Katherine L. Lucot
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Jayne LaGrande
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Dan Mungas
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Charles DeCarli
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Melissa Lamar
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Alifiya Kapasi
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Robert A. Rissman
- Department of Neurosciences, University of California San Diego, San Diego, La Jolla, California
| | - Andrew F. Teich
- Taub Institute for Research on Alzheimer’s Disease and Aging Brain, Department of Neurology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Brittany N. Dugger
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
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9
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Zhu CW, Neugroschl J, Barnes LL, Sano M. Racial/ethnic disparities in initiation and persistent use of anti-dementia medications. Alzheimers Dement 2022; 18:2582-2592. [PMID: 35218291 PMCID: PMC9402814 DOI: 10.1002/alz.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Racial/ethnic disparities in anti-dementia medications use in longitudinally followed research participants are unclear. METHODS The study included initially untreated participants followed in National Alzheimer's Coordinating Center Uniform Data Set who were ≥65 at baseline with Alzheimer's disease dementia. OUTCOMES Outcomes for acetylcholinesterase inhibitor (AChEI) treatment included (1) any new AChEI treatment during follow-up, and (2) persistence of treatment during follow-up categorized into: intermittent treatment (< 50% follow-ups reporting treatment), persistent (≥50% follow-ups), and always treated. Outcomes for memantine treatment were similarly constructed. RESULTS Controlling for participant characteristics, Black and Hispanic participants remained less likely than White participants to report any new AChEI or memantine treatment during follow-up. Among those who reported new treatment during follow-up, both Black and Hispanic participants were less likely than White participants to be persistently treated with AChEI and memantine. DISCUSSION Substantial racial/ethnic treatment disparities remain in controlled settings of longitudinal research in which participants have access to dementia experts, suggesting wider disparities in the larger community.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Judith Neugroschl
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center and Department of Neurological Sciences, Chicago, IL.Rush University Medical Center, Chicago, IL
| | - Mary Sano
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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10
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Goudsmit M, van de Vorst I, van Campen J, Parlevliet J, Schmand B. Clinical characteristics and presenting symptoms of dementia - a case-control study of older ethnic minority patients in a Dutch urban memory clinic. Aging Ment Health 2022; 26:2277-2284. [PMID: 34459695 DOI: 10.1080/13607863.2021.1963416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Despite the suspected higher prevalence of dementia in first generation ethnic minority populations, little is known about their pathway to geriatric diagnostic facilities. This study describes presenting symptoms, demographic and clinical characteristics of a large cohort of patients from ethnic minority populations at their first visit to a geriatric day clinic and compares them with those of native majority (Dutch) patients. METHOD Retrospective case control study in an urban geriatric day clinic setting. Participants were 415 minority patients (cases) from 47 different countries and 428 native Dutch control patients. Measurements were demographic characteristics, cognitive screening results, informant questionnaires, neuropsychiatric and depressive symptoms and somatic comorbidity. RESULTS Ethnic minority patients presented with a different profile of psychiatric and somatic comorbidity. They were younger, had longer duration of symptoms and possibly presented somewhat later in the course of the dementia than the controls. Minority patients had more neuropsychiatric and depressive symptoms than native Dutch patients. They also had more often somatic comorbidities than controls, especially diabetes mellitus. CONCLUSIONS Clinicians in geriatric diagnostic facilities should be aware of the younger age at presentation and the high prevalence of some specific risk factors for dementia in ethnic minority patients.
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Affiliation(s)
- Miriam Goudsmit
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, the Netherlands
| | | | - Jos van Campen
- Department of Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Juliette Parlevliet
- Department of Geriatrics, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Ben Schmand
- Department of Medical Psychology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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11
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Wong JA, Min DK, Kranick J, Ushasri H, Trinh-Shevrin C, Kwon SC. Exploring community knowledge, attitudes and perceptions of Alzheimer's Disease/Alzheimer's Disease-Related Dementias and healthy ageing in Asian American, Native Hawaiian and Pacific Islanders. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5946-e5958. [PMID: 36102595 PMCID: PMC10069713 DOI: 10.1111/hsc.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/22/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Alzheimer's disease and related dementias (AD/ADRD) disparities exist in the rapidly growing and extremely heterogeneous Asian American and Native Hawaiian and Pacific Islander (NH/PI) ageing populations in the United States. Limited community-clinical resources supporting culturally competent and timely diagnosis exacerbate barriers to existing care services in these populations. Community-based participatory research or community-engaged research are proven community-academic research approaches that can support the development and implementation of community-focused programmes to maximise community benefit. The NYU Center for the Study of Asian American Health engaged our national and local community partners to gain a deeper understanding of AD/ADRD in this diverse and growing population, to develop a strategic community-engaged research agenda to understand, address and reduce AD/ADRD disparities among Asian American and NH/PI communities. Findings from an initial scoping review identified significant research gaps. We conducted a series of key informant interviews (n = 11) and a modified Delphi survey (n = 14) with Asian American and NH/PI community leaders and older adult service providers followed by a facilitated group discussion of survey findings to gain consensus on key priority research areas identified in the literature and to determine culturally and contextually appropriate approaches to support AD/ADRD prevention, early identification and treatment in Asian American and NH/PI communities. Future research and health education should focus on raising Asian American and NH/PI basic individual- and community-level awareness about AD/ADRD and leveraging existing community assets to integrate effective engagement strategies to access AD/ADRD services within the healthcare system.
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Affiliation(s)
- Jennifer A. Wong
- Department of Population Health, NYU Grossman School of Medicine
| | - Deborah K. Min
- Department of Population Health, NYU Grossman School of Medicine
| | - Julie Kranick
- Department of Population Health, NYU Grossman School of Medicine
| | | | | | - Simona C. Kwon
- Department of Population Health, NYU Grossman School of Medicine
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12
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Hajjar I, Yang Z, Okafor M, Liu C, Waligorska T, Goldstein FC, Shaw LM. Association of Plasma and Cerebrospinal Fluid Alzheimer Disease Biomarkers With Race and the Role of Genetic Ancestry, Vascular Comorbidities, and Neighborhood Factors. JAMA Netw Open 2022; 5:e2235068. [PMID: 36201209 PMCID: PMC9539715 DOI: 10.1001/jamanetworkopen.2022.35068] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Differences in cerebrospinal fluid (CSF) tau Alzheimer dementia (AD) biomarkers by self-identified race have been observed in prior studies. More recently, plasma biomarkers have been gaining recognition, but whether they exhibit similar differences is unclear. Furthermore, the underlying explanation for these differences in AD biomarkers is still unexplored. OBJECTIVES To investigate differences in plasma biomarkers by race and genetic ancestry and explore potential underlying explanations for these differences. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used participant data from the Brain, Stress, Hypertension, and Aging Research Program (B-SHARP), an observational study conducted in the greater Atlanta metropolitan area. Participants were enrolled from March 1, 2016, to January 1, 2020. MAIN OUTCOMES AND MEASURES Main outcomes were plasma and CSF amyloid-β (Aβ) 42, Aβ40, phosphorylated tau181 (p-tau181), and neurofilament light. General linear models were used for key comparisons. EXPOSURES Main independent variables were self-identified race and genetic ancestry. Additional variables were cardiovascular factors, APOE4, educational attainment, Area Deprivation Index, and C-reactive protein (reflecting systemic inflammation state). RESULTS This analysis included 617 participants (mean [SD] age, 66 [7.9] years; 300 [49%] African American and 317 [51%] White; 429 [70%] with mild cognitive impairment). On the basis of self-reported race, plasma levels of Aβ42 (adjusted mean difference, -1.20 pg/mL; 95% CI, -2.33 to -0.07 pg/mL), Aβ40 (adjusted mean difference, -37.78 pg/mL; 95% CI, -60.16 to -15.39 pg/mL), p-tau181 (adjusted mean difference, -4.66 pg/mL; 95% CI, -7.05 to -1.90 pg/mL), and neurofilament light (adjusted mean difference, -1.58; 95% CI, -2.83 to -0.19 pg/mL) were consistently lower in African American individuals after adjusting for demographic characteristics, educational attainment, cognition, APOE4, and cardiovascular factors. A similar pattern was observed in the CSF biomarkers except for Aβ42 and Aβ40. Although unadjusted analyses revealed an association between these biomarkers and African ancestry, these associations were not significant after adjusting for the same covariates. Differences by self-reported race were not explained by varied cardiovascular risk factors, C-reactive protein, educational attainment, or Area Deprivation Index. CONCLUSIONS AND RELEVANCE In this cross-sectional study of plasma biomarkers by race and genetic ancestry, the results indicated that plasma p-tau181, Aβ40, and NFL were lower in African American individuals based on self-reported race but not genetic ancestry. These differences were not explained by cardiovascular risks or clinical stage differences. These racial differences should be considered in clinical interpretations and clinical trial screenings to avoid an additional increase in underrepresentation of African American individuals in AD trials.
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Affiliation(s)
- Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
- Department of Neurology, University of Texas Southwestern, Dallas
| | - Zhiyi Yang
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Maureen Okafor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Chang Liu
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Teresa Waligorska
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia
| | | | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia
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13
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Chalmer R, Ayers E, Weiss EF, Malik R, Ehrlich A, Wang C, Zwerling J, Ansari A, Possin KL, Verghese J. The 5-Cog paradigm to improve detection of cognitive impairment and dementia: clinical trial protocol. Neurodegener Dis Manag 2022; 12:171-184. [PMID: 35603666 PMCID: PMC9245592 DOI: 10.2217/nmt-2021-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022] Open
Abstract
Cognitive impairment related to dementia is under-diagnosed in primary care despite availability of numerous cognitive assessment tools; under-diagnosis is more prevalent for members of racial and ethnic minority groups. Clinical decision-support systems may improve rates of primary care providers responding to positive cognitive assessments with appropriate follow-up. The 5-Cog study is a randomized controlled trial in 1200 predominantly Black and Hispanic older adults from an urban underserved community who are presenting to primary care with cognitive concerns. The study will validate a novel 5-minute cognitive assessment coupled with an electronic medical record-embedded decision tree to overcome the barriers of current cognitive assessment paradigms in primary care and facilitate improved dementia care.
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Affiliation(s)
- Rachel Chalmer
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Emmeline Ayers
- Department of Neurology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Erica F Weiss
- Department of Neurology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Rubina Malik
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Amy Ehrlich
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Cuiling Wang
- Department of Epidemiology & Population Health, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jessica Zwerling
- Department of Neurology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Asif Ansari
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Katherine L Possin
- Department of Neurology, Memory & Aging Center, University of California San Francisco, San Francisco, CA 94158, USA
| | - Joe Verghese
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
- Department of Neurology, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY 10467, USA
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14
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Lee S, Kim D, Lee H. Examine Race/Ethnicity Disparities in Perception, Intention, and Screening of Dementia in a Community Setting: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148865. [PMID: 35886711 PMCID: PMC9321249 DOI: 10.3390/ijerph19148865] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
Background: Delayed detection and diagnosis of Alzheimer’s Disease and related dementia (ADRD) can lead to suboptimal care and socioeconomic burdens on individuals, families, and communities. Our objective is to investigate dementia screening behavior focusing on minority older populations and assess whether there are ethnic differences in ADRD screening behavior. Methods: The scoping review method was utilized to examine ADRD screening behavior and contributing factors for missed and delayed screening/diagnosis focusing on race/ethnicity. Results: 2288 papers were identified, of which 21 met the inclusion criteria. We identified six dimensions of ADRD screening behavior: Noticing Symptoms, Recognizing a problem, Accepting Screen, Intending Screen, Action, and Integrating with time. Final findings were organized into study race/ethnicity, theoretical background, the methods of quantitative and qualitative studies, description and measures of ADRD screening behavior, and racial/ethnic differences in ADRD screening behavior. Conclusions: A trend in ethnic disparities in screening for ADRD was observed. Our findings point to the fact that there is a scarcity of studies focusing on describing ethnic-specific ADRD screening behavior as well as a lack of those examining the impact of ethnicity on ADRD screening behavior, especially studies where Asian Americans are almost invisible.
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15
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Nguyen ML, Huie EZ, Whitmer RA, George KM, Dugger BN. Neuropathology Studies of Dementia in US Persons other than Non-Hispanic Whites. FREE NEUROPATHOLOGY 2022; 3. [PMID: 35425946 PMCID: PMC9007571 DOI: 10.17879/freeneuropathology-2022-3795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia are two of the most prevalent dementias that afflict the aging population in the United States (US). Studies have made great strides in understanding the neuropathology of these diseases; however, many studies are conducted in the context of non-Hispanic whites (NHWs), and few include the rapidly growing underrepresented populations that reside in the US. We sought to characterize current knowledge of the neuropathologic landscape of AD and vascular dementia of the largest growing US minority groups, namely Latinos/Hispanics, Black Americans, and Asian Americans, compared with NHWs being the majority group. It is vital to note these historic categories are social constructs and cultural and social associations may underlie differences. We conducted a literature search utilizing specific criteria to yield neuropathology papers that addressed the demographics and neuropathologies of relevance, then collated the findings into this review. We reveal that while there has been much progress in neuropathological research involving Latinos/Hispanics and Black Americans in the past decade, no cohesive conclusions could be extrapolated from the existing data due to the dearth of minority participants and even smaller amount of information related to the heterogeneity within each minority group, especially Latinos/Hispanics. Furthermore, we reveal an even greater scarcity in neuropathological studies involving Asian Americans, also a very heterogeneous group. We hope the presented findings will illuminate the paucity of minority representation in not just neuropathological research but the field of clinical research overall and serve to inspire clinicians and researchers to help reduce the health disparities underrepresented groups in the US face.
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Affiliation(s)
- My-le Nguyen
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Emily Z Huie
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, University of California, Davis
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16
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Browning JA, Tsang CCS, Dong X, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Liu C, Wang J. Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis. BMC Health Serv Res 2022; 22:159. [PMID: 35130899 PMCID: PMC8822650 DOI: 10.1186/s12913-022-07483-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.
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Affiliation(s)
- Jamie A Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN, 38163, USA
| | - Marie A Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Christopher K Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jack W Tsao
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap St, Memphis, 38105, USA.,Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN, 38163, USA
| | - Colin Liu
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, 19104, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
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17
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Brijnath B, Croy S, Sabates J, Thodis A, Ellis S, de Crespigny F, Moxey A, Day R, Dobson A, Elliott C, Etherington C, Geronimo MA, Hlis D, Lampit A, Low L, Straiton N, Temple J. Including ethnic minorities in dementia research: Recommendations from a scoping review. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12222. [PMID: 35505899 PMCID: PMC9053375 DOI: 10.1002/trc2.12222] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/18/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Introduction Ethnicity influences dementia etiology, prognosis, and treatment, while culture shapes help‐seeking and care. Despite increasing population diversity in high‐income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research. Methods We did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high‐income countries were included. A steering group of experts developed criteria through which high‐quality studies were identified. Results Sixty‐six articles were retrieved (51 observational; 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty‐three studies translated or used a culturally validated instrument. Twenty‐three articles conducted subgroup analyses based on ethnicity. Six high‐quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic diversity, and adjusted/substratified to analyze the impact of ethnicity on dementia. Discussion We make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural diversity in dementia research.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute Parkville Victoria Australia
- School of Social Sciences University of Western Australia Western Australia Perch Australia
| | - Samantha Croy
- Centre for Population Genomics Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Julieta Sabates
- Academic Unit for Psychiatry of Old Age University of Melbourne Parkville Victoria Australia
| | - Antonia Thodis
- National Ageing Research Institute Parkville Victoria Australia
| | - Stephanie Ellis
- ACT Health Directorate Australian Capital Territory Australia
| | - Fleur de Crespigny
- Australian Institute of Health and Welfare Canberra Australian Capital Territory Australia
| | - Annette Moxey
- Dementia Australia Research Foundation Griffith Australian Capital Territory Australia
| | - Robert Day
- Australian Government Department of Health Canberra Australian Capital Territory Australia
| | - Annette Dobson
- School of Public Health University of Queensland Herston Queensland Australia
| | | | - Cathy Etherington
- Australian Bureau of Statistics Belconnen Australian Capital Territory Australia
| | - Mary Ann Geronimo
- Federation of Ethnic Community Councils of Australia Deakin Australian Capital Territory Australia
| | - Danijela Hlis
- Consumer Representative Buderim Queensland Australia
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age University of Melbourne Parkville Victoria Australia
| | - Lee‐Fay Low
- Sydney School of Health Sciences University of Sydney Camperdown New South Wales Australia
| | - Nicola Straiton
- NHMRC Clinical Trials Centre Sydney New South Wales Australia
| | - Jeromey Temple
- School of Population and Global Health University of Melbourne Parkville Victoria Australia
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Rubin L, Ingram LA, Resciniti NV, Ashford-Carroll B, Leith KH, Rose A, Ureña S, McCollum Q, Friedman DB. Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review. Front Public Health 2021; 9:784958. [PMID: 35004586 PMCID: PMC8739784 DOI: 10.3389/fpubh.2021.784958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.
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Affiliation(s)
- Lindsey Rubin
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Brianna Ashford-Carroll
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Katherine Henrietta Leith
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Aubrey Rose
- School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Stephanie Ureña
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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Ferguson SA, Panos JJ, Sloper D, Varma V, Sarkar S. Alzheimer's disease: a step closer to understanding type 3 diabetes in African Americans. Metab Brain Dis 2021; 36:1803-1816. [PMID: 34021875 DOI: 10.1007/s11011-021-00754-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Alzheimer's disease (AD) is the fourth leading cause of death in the United States and the most common cause of adult-onset dementia. Recent results suggest an increased prevalence and severity in African Americans compared to Caucasians. Our understanding of the potential mechanism(s) underlying this ethnicity difference is limited. We previously described ethnicity-related differences in levels of neurodegenerative proteins and cytokines/chemokines in the BA21 region of African Americans and Caucasians with AD. Here, similar multiplex assays were used to examine those endpoints in patient postmortem cerebrospinal fluid (CSF). Additionally, we measured levels of C-peptide, ghrelin, gastric inhibitory polypeptide (GIP), glucagon-like peptide-1 (GLP-1), glucagon, insulin, leptin, PAI-1, resistin, and visfatin using a human diabetes 10-plex assay. The cytokine and chemokine assays revealed that levels of 26 chemokines or cytokines differed significantly with ethnicity, and three of those were significantly associated with gender. The neurodegenerative disease panel indicated that levels of soluble RAGE were significantly elevated in African Americans compared to Caucasians. All measures in the diabetes disease panel assay were significantly elevated in African Americans: ghrelin, GIP, GLP-1, glucagon, insulin, and visfatin. Through peripheral sample analysis, these results provide further evidence that ethnicity is critically involved in the manifestation of AD.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Sumit Sarkar
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA.
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20
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Lin PJ, Daly AT, Olchanski N, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM. Dementia Diagnosis Disparities by Race and Ethnicity. Med Care 2021; 59:679-686. [PMID: 34091580 PMCID: PMC8263486 DOI: 10.1097/mlr.0000000000001577] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups. OBJECTIVE The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia. RESEARCH DESIGN This was a prospective cohort study. SUBJECTS A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims. MEASURES We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity. RESULTS A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites. CONCLUSIONS Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Allan T. Daly
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | | | - Karen M. Freund
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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21
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Massett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, Gallop-Goodman G, McGowan M. Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review. J Alzheimers Dis 2021; 82:107-127. [PMID: 33998537 DOI: 10.3233/jad-201463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.
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Affiliation(s)
- Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, USA
| | - Gerda Gallop-Goodman
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Melissa McGowan
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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22
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Aranda MP, Kremer IN, Hinton L, Zissimopoulos J, Whitmer RA, Hummel CH, Trejo L, Fabius C. Impact of dementia: Health disparities, population trends, care interventions, and economic costs. J Am Geriatr Soc 2021; 69:1774-1783. [PMID: 34245588 PMCID: PMC8608182 DOI: 10.1111/jgs.17345] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The dementia experience is not a monolithic phenomenon-and while core elements of dementia are considered universal-people living with dementia experience the disorder differently. Understanding the patterning of Alzheimer's disease and related dementias (ADRD) in the population with regards to incidence, risk factors, impacts on dementia care, and economic costs associated with ADRD can provide clues to target risk and protective factors for all populations as well as addressing health disparities. METHODS We discuss information presented at the 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers, Theme 1: Impact of Dementia. In this article, we describe select population trends, care interventions, and economic impacts, health disparities and implications for future research from the perspective of our diverse panel comprised of academic stakeholders, and persons living with dementia, and care partners. RESULTS Dementia incidence is decreasing yet the advances in population health are uneven. Studies examining the educational, geographic and race/ethnic distribution of ADRD have identified clear disparities. Disparities in health and healthcare may be amplified by significant gaps in the evidence base for pharmacological and non-pharmacological interventions. The economic costs for persons living with dementia and the value of family care partners' time are high, and may persist into future generations. CONCLUSIONS Significant research gaps remain. Ensuring that ADRD healthcare services and long-term care services and supports are accessible, affordable, and effective for all segments of our population is essential for health equity. Policy-level interventions are in short supply to redress broad unmet needs and systemic sources of disparities. Whole of society challenges demand research producing whole of society solutions. The urgency, complexity, and scale merit a "whole of government" approach involving collaboration across numerous federal agencies.
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Affiliation(s)
| | - Ian N. Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer’s Disease)
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23
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Fernandez ML. Lifestyle Factors and Genetic Variants Associated to Health Disparities in the Hispanic Population. Nutrients 2021; 13:2189. [PMID: 34202120 PMCID: PMC8308310 DOI: 10.3390/nu13072189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Non-communicable diseases including type 2 diabetes mellitus, coronary heart disease, hepatic steatosis, and cancer are more prevalent in minority groups including Hispanics when compared to Non-Hispanic Whites, leading to the well-recognized terminology of health disparities. Although lifestyle factors including inadequate dietary habits, decreased physical activity, and more prominently, an unhealthy body weight, may be partly responsible for this disproportion in chronic diseases, genetic variations also make a substantial contribution to this problem. In this review, the well-recognized obesity problem in Hispanics that has been associated with chronic disease is examined as well as the influence of diet on promoting an inflammatory environment leading to increased cardiometabolic risk, insulin resistance, fatty liver disease, and cancer. In addition, some of the more studied genetic variations in Hispanics and their association with chronic disease is reviewed.
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Affiliation(s)
- Maria Luz Fernandez
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
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24
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Hispanic ethnicity and in-hospital morbidity and mortality outcomes in Alzheimer's Disease: A U.S. National Study 2005-2015. Clin Neurol Neurosurg 2021; 207:106753. [PMID: 34126451 DOI: 10.1016/j.clineuro.2021.106753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/17/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hispanics are one of the largest and fastest-growing population in the United States. Having been reported as one of the high-risk ethnicities to develop Alzheimer's Disease (AD) makes elder Hispanics one of the significant groups of AD in the country, indicating a need to study the disparities in Hispanics vs. non-Hispanics patients. We aimed to determine the prevalence, morbidity, and mortality outcomes of AD in Hispanics. METHODS We surveyed Healthcare Cost and Utilization Project (HCUP) from 2005 to 2015 to identify patients older than 50 years who were admitted for any reason and had AD diagnosis. Prevalence, demographics, age brackets, in-hospital deaths, disease severity, and hospital length of stay (LOS) were compared between the Hispanics and Non-Hispanics. RESULTS Among 14,135,560 Hispanic discharges, 2.76% had AD, compared with 207,515,260 discharges in Non-Hispanic with 2.61% AD, p < 0.001. Hispanics had significantly more AD in all age brackets, especially over 90 years of age, p < 0.001. A significantly higher prevalence of AD in both Hispanic Females (3.27% vs. 3.10%) and Males (2.17% vs. 2.04%) was noticed, p < 0.001. In northeast and south regions of the country and urban hospitals, AD was more among Hispanics (p < 0.001). Hispanic patients were younger (81.8 ± 7.77 vs. 82.6 ± 7.50, p < 0.001), had longer LOS (6.41 ± 7.72 vs. 6.08 ± 7.05, p < 0.001), had higher hospital charges ($45,989 vs. $37,688, p < 0.001). Hispanic AD patients had higher disease severity and mortality risk (p < 0.001). However, the inpatient mortality was not different between the Hispanic and non-Hispanics. Multivariate analysis showed that Hispanics had the highest AD prevalence in the inpatient setting (OR, 1.38; 95% CI, 1.37-1.39, p < 0.001). CONCLUSION The prevalence of AD was significantly higher in inpatient Hispanics than non-Hispanics. Hispanic AD patients had a younger age compared with non-Hispanic AD. Disease severity and mortality risks were higher in Hispanics with AD than non-Hispanics with AD. However, no difference was seen in mortality rate during admission in Hispanics vs. non-Hispanics.
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25
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Lind KE, Hildreth K, Lindrooth R, Morrato E, Crane LA, Perraillon MC. The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates. Health Serv Res 2021; 56:193-203. [PMID: 33481263 DOI: 10.1111/1475-6773.13627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the relationship between direct cognitive assessment introduced with the Medicare Annual Wellness Visit (AWV) and new diagnoses of dementia, and to determine if effects vary by race. DATA SOURCES Medicare Limited Data Set 5% sample claims 2003-2014 and the HRSA Area Health Resources Files. STUDY DESIGN Instrumental Variable approach estimating the relationship between AWV utilization and new diagnoses of dementia using county-level Welcome to Medicare Visit rates as an instrument. DATA COLLECTION/EXTRACTION METHODS Three hundred twenty-four thousand three hundred and eighty-five fee-for-service Medicare beneficiaries without dementia when the AWV was introduced in 2011. PRINCIPAL FINDINGS Annual Wellness Visit utilization was associated with an increased probability of new dementia diagnosis with effects varying by racial group (categorized as white, black, Hispanic/Latino, or Asian based on Social Security Administration data). Hazard ratios (95% confidence intervals) for new dementia diagnosis within 6 months of AWV utilization were as follows: 2.34 (2.13, 2.58) white, 2.22 (1.71, 2.89) black, 4.82 (2.94, 7.89) Asian, and 6.14 (3.70, 10.19) Hispanic (P < .001 for each). Our findings show that estimates that do not control for selection underestimate the effect of AWV on new diagnoses. CONCLUSIONS Dementia diagnosis rates increased with AWV implementation with heterogenous effects by race and ethnicity. Current recommendations by the United States Preventive Services Task Force state that the evidence is insufficient to recommend for or against screening for cognitive impairment in older adults.
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Affiliation(s)
- Kimberly E Lind
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kerry Hildreth
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Richard Lindrooth
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Elaine Morrato
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lori A Crane
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
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26
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Specktor P, Ben Hayun R, Yarovinsky N, Fisher T, Aharon Peretz J. Ethnic Differences in Attending a Tertiary Dementia Clinic in Israel. Front Neurol 2021; 11:578068. [PMID: 33519666 PMCID: PMC7838485 DOI: 10.3389/fneur.2020.578068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/10/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Variations in lifestyle, socioeconomic status and general health likely account for differences in dementia disparities across racial groups. Our aim was to evaluate the characteristics of Arab (AS) and Jewish (JS) subjects attending a tertiary dementia clinic in Israel. Methods: Retrospective data regarding subjects attending the Cognitive Neurology Institute at Rambam Health Care Campus between April 1, 2010, and April 31, 2016, for complaints of cognitive decline were collected from the institutional registry. AS and consecutive JS, aged ≥50 years without a previous history of structural brain disease, were included. Results: The records of 6,175 visits were found; 3,246 subjects were ≥50 years at the initial visit. One hundred and ninety-nine AS and consecutive JS cases were reviewed. Mean age at first visit was 68.4 ± 8.8 for AS and 74.3 for JS (p < 0.0001). Mean education was 7.7 ± 4.8 years for AS and 11.3 years for JS (p < 0.0001). Mean duration of cognitive complaints prior to first visit did not differ between the groups. Initial complaints of both ethnicities were failing memory (97%) and behavioral changes (59%). Functional impairment was reported by 59% of AS and 45% of JS (p = 0.005). MMSE on first evaluation was 19.2 ± 7 for AS and 23.1 ± 5.9 for JS; p = 0.001. Alzheimer's disease was diagnosed in 32% AS and 23% JS, mild cognitive impairment in 12% AS and 21% JS. Normal cognition was diagnosed in 2% AS and 9% JS; p = 0.0001. Conclusions: Compared to JS, AS attend a tertiary clinic when their cognitive impairment already affects their functional abilities providing a comprehensive benchmark for social health care interventions to reduce disparities.
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Affiliation(s)
- Polina Specktor
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Rachel Ben Hayun
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel
| | | | - Tali Fisher
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Judith Aharon Peretz
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Haifa, Israel
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27
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Comparing fluid biomarkers of Alzheimer's disease between African American or Black African and white groups: A systematic review and meta-analysis. J Neurol Sci 2020; 421:117270. [PMID: 33349466 DOI: 10.1016/j.jns.2020.117270] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
RATIONALE Biomarker research for Alzheimer's disease (AD) has grown rapidly in recent years, ensuing the integration of the AD fluid biomarker profile: Aβ1-42, t-tau, and p-tau181, into clinical and research criteria. However, current insights of AD arise almost exclusively from studies on white individuals. Some studies have revealed that epidemiology, clinical features, and genetics of AD show variations between individuals from black and white backgrounds, conveying the importance of ethnoracial differences, and the possibility of such differences also influencing AD biomarker levels. This systematic review explored whether AD fluid biomarker levels differ between African American (AA) or Black African and white groups. AIM To compare AD fluid biomarkers (Aβ1-42, p-tau181, and t-tau) levels between AA or Black Africans and white individuals. METHOD PubMed, Scopus, and other sources were explored for studies that quantified AD biomarkers in biological fluid from whites and AA or Black African groups. Meta-analyses were performed to find the standardized mean difference for biomarkers that were quantified in ≥3 studies. RESULTS Five studies were included; studies on Black Africans were not found. The meta-analyses found CSF t-tau and p-tau181 were consistently lower in AA than white individuals, in samples with normal cognition or with mild cognitive impairment/dementia. CONCLUSIONS The meta-analyses found significant differences for CSF tau between AA and white individuals with normal cognition and within the dementia spectrum, expressing the importance of taking into account ethnoracial factors when interpreting CSF AD biomarkers levels. However, the generalisability of these differences is restricted by small samples' size, lack of unified methodologies and recruitment's biases within studies; further large multicentre studies with harmonized protocols and sufficient power are imperative to investigate the extent of ethnoracial differences across the spectrum of cognitive decline, with vaster efforts necessary to diversify recruitment.
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28
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Co M, Couch E, Gao Q, Mac-Ginty S, Das-Munshi J, Prina M. Access to Health Services in Older Minority Ethnic Groups with Dementia: A Systematic Review. J Am Geriatr Soc 2020; 69:822-834. [PMID: 33230815 PMCID: PMC7984264 DOI: 10.1111/jgs.16929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES While it is acknowledged that minority ethnic (ME) groups across international settings face barriers to accessing care for dementia, it is not clear whether ME groups access services less frequently as a result. The objective of this review is to examine whether ME groups have longer delays before accessing dementia/memory services, higher use of acute care and crisis services and lower use of routine care services based on existing literature. We also examined whether ME groups had higher dementia severity or lower cognition when presenting to memory services. DESIGN Systematic review with narrative synthesis. SETTING Nonresidential medical, psychiatric, memory, and emergency services. PARTICIPANTS Twenty studies totaling 94,431 older adults with dementia or mild cognitive impairment. MEASUREMENTS We searched Embase, Ovid MEDLINE, Global Health, and PsycINFO from inception to November 2018 for peer-reviewed observational studies which quantified ethnic minority differences in nonresidential health service use in people with dementia. Narrative synthesis was used to analyze findings. RESULTS Twenty studies were included, mostly from the U.S. (n = 13), as well as the UK (n = 4), Australia (n = 1), Belgium (n = 1), and the Netherlands (n = 1). There was little evidence that ME groups in any country accessed routine care at different rates than comparison groups, although studies may have been underpowered. There was strong evidence that African American/Black groups had higher use of hospital inpatient services versus U.S. comparison groups. Primary care and emergency services were less well studied. Study quality was mixed, and there was a large amount of variability in the way ethnicity and service use outcomes were ascertained and defined. CONCLUSION There is evidence that some ME groups, such as Black/African American groups in the U.S., may use more acute care services than comparison populations, but less evidence for differences in routine care use. Research is sparse, especially outside the U.S.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Scarlett Mac-Ginty
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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29
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Alcendor DJ. Dysregulation of Endothelin-1: Implications for Health Disparities in Alzheimer's Disease. J Pers Med 2020; 10:E199. [PMID: 33126567 PMCID: PMC7712547 DOI: 10.3390/jpm10040199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) and related dementias disproportionately impact racial and ethnic minorities. The racial and ethnic disparities in AD could be explained by differences in cerebral vascular disease pathology. Endothelin-1 (ET-1) is a potent vasoconstrictive peptide that regulates smooth muscle, endothelial cell, and pericyte contractions that may result in cerebral vascular constriction, leading to cerebral hypoperfusion; over time, ET-1 may result in neuronal injury contributing to the pathology of AD. Upregulation of the ET-1 system has been observed in African Americans when compared with non-Hispanic Whites. The role of the ET-1 system as a driver of ethnic disparities in AD requires further investigation. Targeting of the ET-1 system as a therapeutic intervention that could impact AD progression also needs further study. Dysregulation of ET-1 in Hispanic/Latino populations largely have been unexplored. Genetics linking ET-1 dysregulation and racial disparities in AD also needs further investigation. In this review, I examine how AD effects underserved minority populations and how dysregulation of the ET-1 system specifically predisposes ethnic minorities to AD. In addition, I examine the molecular interactions of the ET-1 system and amyloid beta, the role the ET-1 system in neurodegeneration, potential therapeutics for ET-1 dysregulation, and the impact on AD progression.
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Affiliation(s)
- Donald J Alcendor
- Center for AIDS Health Disparities Research, Department of Microbiology, Immunology and Physiology, School of Medicine, Meharry Medical College, Nashville, TN 37208, USA
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Balbim GM, Maldonado AM, Early A, Steinman L, Harkins K, Marquez DX. Evaluation of Public Health Messages Promoting Early Detection of Dementia Among Adult Latinos With a Living Older Adult Parental Figure. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:163-173. [PMID: 32126826 PMCID: PMC7542987 DOI: 10.1177/1540415320908535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We aimed to evaluate the resonance of public health messages promoting early detection of dementia in adult Latinos with a living older adult loved one. METHOD We conducted a mixed-methods study with focus groups and surveys to evaluate eight messages encouraging Latino adults to accompany their older loved one for cognitive assessment. Qualitative data were transcribed and coded, and thematic analysis was conducted. We used descriptive statistics for quantitative data. RESULTS Participants suggested that messages need to be translated into Spanish and images need to be more natural, present balance between positive and serious facial expressions, show more ethnic/racial diversity, and show family members other than the parents. Five major sociocultural themes affected how the messages were received: stigma, gender roles, the importance of the mother figure, guilt, and family togetherness. CONCLUSION Public health messages targeting cultural values are needed to effectively encourage early dementia detection in Latinos. Findings can be used to adapt culturally appropriate public health messages encouraging early dementia detection in Latinos.
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Affiliation(s)
| | | | - Amy Early
- University of Illinois at Chicago, Chicago, IL, USA
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Barnes-Marrero I, Horter L, Hayden JD, Patel NC, Mendoza L, Castillo L. Diagnostic accuracy of the repeatable battery of the assessment of neuropsychological status update, Spanish version, in predicting Alzheimer's disease among Hispanic older adults in the United States reporting memory problems. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:509-519. [PMID: 32584154 DOI: 10.1080/23279095.2020.1777554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: There are few standardized, Spanish-language diagnostic tools to help identify Hispanic persons at early stages of Alzheimer's disease (AD). This study evaluated the accuracy of the Spanish version of the Repeatable Battery for the Assessment of Neuropsychological Status-Update (RBANS) in predicting AD in older Hispanic adults in the United States reporting memory problems.Methods: We analyzed data from age, sex, and education level propensity score-matched Hispanic memory clinic patients with (n = 38) and without (n = 38) a clinical diagnosis of AD. Estimates of diagnostic accuracy included sensitivity, specificity, predictive value, and receiver operating characteristic analysis.Results: After controlling for sex and matched pairs, the Total Scale score [area under curve (AUC) = 0.7417] and the Immediate (AUC = 0.7258) and Delayed (AUC = 0.7735) Memory index scores provided better estimates of diagnostic accuracy than Language, Attention, and Visuospatial/Constructional index scores. A minus 2-standard deviation (SD) cut point enhanced the predictive probability of the Delayed Memory index score. A cut point of -1.5 SD optimized the predictive probability of the Total Scale score.Conclusions: These results suggest that optimal cutoff values for the RBANS Delayed Memory index and Total Scale scores that may help identify Hispanic patients with AD as part of a comprehensive diagnostic AD assessment.
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Affiliation(s)
| | - Libby Horter
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | | | - Nick C Patel
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | - Lisandra Mendoza
- Department of Clinical Psychology, Albizu University, Miami, FL, USA
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Ferguson SA, Varma V, Sloper D, Panos JJ, Sarkar S. Increased inflammation in BA21 brain tissue from African Americans with Alzheimer's disease. Metab Brain Dis 2020; 35:121-133. [PMID: 31823110 DOI: 10.1007/s11011-019-00512-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/25/2019] [Indexed: 12/21/2022]
Abstract
Chronic neuroinflammation is strongly associated with AD and altered peripheral and central levels of chemokines and cytokines have been frequently described in those with AD. Given the increasing evidence of ethnicity-related differences in AD, it was of interest to determine if those altered chemokine and cytokine levels are ethnicity-related. Because African Americans exhibit a higher incidence of AD and increased symptom severity, we explored chemokine and cytokine concentrations in post-mortem brain tissue from the BA21 region of African Americans and Caucasians with AD using multiplex assays. IL-1β, MIG, TRAIL, and FADD levels were significantly increased in African Americans while levels of IL-3 and IL-8 were significantly decreased. Those effects did not interact with gender; however, overall levels of CCL25, CCL26 and CX3CL1 were significantly decreased in women. The NLRP3 inflammasome is thought to be critically involved in AD. Increased activation of this inflammasome in African Americans is consistent with the current results.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA.
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA
| | - Sumit Sarkar
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA
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Kurasz AM, Smith GE, McFarland MG, Armstrong MJ. Ethnoracial Differences in Lewy Body Diseases with Cognitive Impairment. J Alzheimers Dis 2020; 77:165-174. [PMID: 32804137 PMCID: PMC7553012 DOI: 10.3233/jad-200395] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing research focuses on ethnic differences in Alzheimer's disease, but such efforts in other neurodegenerative dementias are lacking. Currently, data on the ethnic profile of cognitively impaired persons with Lewy body disease (LBD) is limited, despite Lewy body dementia being the second most common neurodegenerative dementia. OBJECTIVE The study aimed to investigate presenting characteristics among ethnoracially diverse individuals with cognitive impairment secondary to LBD using the National Alzheimer's Coordinating Center database. METHODS Participants self-identified as African American, Hispanic, or White. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in presenting characteristics and linear regression to compare neuropsychological test performance. RESULTS Presentation age was similar between groups (median 74-75 years). Compared to Whites (n = 1782), African Americans (n = 130) and Hispanics (n = 122) were more likely to be female and single, have less educational attainment, report more cardiovascular risk factors, describe less medication use, and perform worse on select cognitive tests. Hispanics reported more depressive symptoms. CONCLUSION Cohorts differences highlight the need for population-based LBD studies with racial-ethnic diversity. Culturally-sensitive neuropsychological tests are needed to determine whether observed differences relate to cultural, social, testing, or disease-related factors. More research is needed regarding how social and biological factors impact LBD care among diverse populations.
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Affiliation(s)
- Andrea M. Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Glenn E. Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
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Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:891-898. [PMID: 31890853 PMCID: PMC6926355 DOI: 10.1016/j.trci.2019.11.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
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Chen Y, Tysinger B, Crimmins E, Zissimopoulos JM. Analysis of dementia in the US population using Medicare claims: Insights from linked survey and administrative claims data. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:197-207. [PMID: 31198838 PMCID: PMC6556828 DOI: 10.1016/j.trci.2019.04.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction Medicare claims data may be a rich data source for tracking population dementia rates. Insufficient understanding of completeness of diagnosis, and for whom, limits their use. Methods We analyzed agreement in prevalent and incident dementia based on cognitive assessment from the Health and Retirement Study for persons with linked Medicare claims from 2000 to 2008 (N = 10,450 persons). Multinomial logistic regression identified sociodemographic factors associated with disagreement. Results Survey-based cognitive tests and claims-based dementia diagnosis yielded equal prevalence estimates, yet only half were identified by both measures. Race and education were associated with disagreement. Eighty-five percent of respondents with incident dementia measured by cognitive decline received a diagnosis or died within the study period, with lower odds among blacks and Hispanics than among whites. Discussions Claims data are valuable for tracking dementia in the US population and improve over time. Delayed diagnosis may underestimate rates within black and Hispanic populations.
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Affiliation(s)
- Yi Chen
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Eileen Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Julie M. Zissimopoulos
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
- Corresponding author. Tel.: +213 821 7947; Fax: +213 740 3460.
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Burke SL, Naseh M, Rodriguez MJ, Burgess A, Loewenstein D. Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations. PSYCHOLOGY & NEUROSCIENCE 2019; 12:144-168. [PMID: 31649798 PMCID: PMC6812579 DOI: 10.1037/pne0000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments.
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Affiliation(s)
- Shanna L Burke
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | | | - Aaron Burgess
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - David Loewenstein
- Center on Aging as the Center for Cognitive Neuroscience and Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami
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Silzer T, Barber R, Sun J, Pathak G, Johnson L, O’Bryant S, Phillips N. Circulating mitochondrial DNA: New indices of type 2 diabetes-related cognitive impairment in Mexican Americans. PLoS One 2019; 14:e0213527. [PMID: 30861027 PMCID: PMC6414026 DOI: 10.1371/journal.pone.0213527] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
Mitochondrial function has been implicated and studied in numerous complex age-related diseases. Understanding the potential role of mitochondria in disease pathophysiology is of importance due to the rise in prevalence of complex age-related diseases, such as type 2 diabetes (T2D) and Alzheimer's disease (AD). These two diseases specifically share common pathophysiological characteristics which potentially point to a common root cause or factors for disease exacerbation. Studying the shared phenomena in Mexican Americans is of particular importance due to the disproportionate prevalence of both T2D and AD in this population. Here, we assessed the potential role of mitochondria in T2D and cognitive impairment (CI) in a Mexican American cohort by analyzing blood-based indices of mitochondrial DNA copy number (mtDNACN) and cell-free mitochondrial DNA (CFmtDNA). These mitochondrial metrics were also analyzed for correlation with relevant neuropsychological variables and physiological data collected as indicators of disease and/or disease progression. We found mtDNACN to be significantly decreased in individuals with CI, while CFmtDNA was significantly elevated in T2D; further, CFmtDNA elevation was significantly exacerbated in individuals with both diseases. MtDNACN was found to negatively correlate with age and fatty acid binding protein concentration, while positively correlating with CFmtDNA as well as CERAD total recall score. Candidate gene SNP-set analysis was performed on genes previously implicated in maintenance and control of mitochondrial dynamics to determine if nuclear variants may account for variability in mtDNACN. The results point to a single significant locus, in the LRRK2/MUC19 region, encoding leucine rich repeat kinase 2 and mucin 19. This locus has been previously implicated in Parkinson's disease, among others; rs7302859 was the driver SNP. These combined findings further indicate that mitochondrial dysfunction (as assessed by proxy via mtDNACN) is intimately linked to both T2D and CI phenotypes as well as aging.
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Affiliation(s)
- Talisa Silzer
- Department of Microbiology, Immunology, Genetics, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
- * E-mail:
| | - Robert Barber
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Jie Sun
- Department of Microbiology, Immunology, Genetics, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Gita Pathak
- Department of Microbiology, Immunology, Genetics, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Leigh Johnson
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Sid O’Bryant
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Nicole Phillips
- Department of Microbiology, Immunology, Genetics, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
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Silzer TK, Phillips NR. Etiology of type 2 diabetes and Alzheimer's disease: Exploring the mitochondria. Mitochondrion 2018; 43:16-24. [DOI: 10.1016/j.mito.2018.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/16/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
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Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of Dementia: an Observational Study of Patterns in Diagnosis and Awareness in US Older Adults. J Gen Intern Med 2018; 33:1131-1138. [PMID: 29508259 PMCID: PMC6025653 DOI: 10.1007/s11606-018-4377-y] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/28/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many older adults living with dementia have not been formally diagnosed. Even when clinicians document the diagnosis, patients and families may be unaware of the diagnosis. Knowledge of how individual characteristics affect detection and awareness of dementia is limited. OBJECTIVE To identify characteristics associated with dementia diagnosis and awareness of diagnosis. DESIGN Cross-sectional observational study. PARTICIPANTS Five hundred eighty-five adults aged ≥ 65 in the National Health and Aging Trends Study who met assessment-based study criteria for probable dementia in 2011 and had 3 years of continuous, fee-for-service Medicare claims prior to 2011. MAIN MEASURES Using multivariable logistic regression, we compared participants with undiagnosed versus diagnosed dementia (based on Medicare claims) on demographic, social/behavioral, functional, medical, and healthcare utilization characteristics. Among those diagnosed, we compared characteristics of participants unaware versus aware of the diagnosis (based on self or proxy report). KEY RESULTS Among older adults with probable dementia, 58.7% were either undiagnosed (39.5%) or unaware of the diagnosis (19.2%). In adjusted analyses, individuals who were Hispanic (OR 2.48, 95% CI 1.19, 5.14), had less than high school education (OR 0.54 for at least high school education, 95% CI 0.32, 0.91), attended medical visits alone (OR 1.98, 95% CI 1.11, 3.51), or had fewer functional impairments (OR 0.79 for each impairment, 95% CI 0.69, 0.90) were more likely to be undiagnosed. Similarly, among those diagnosed, having less education (OR 0.42), attending medical visits alone (OR 1.97), and fewer functional impairments (OR 0.72) were associated with unawareness of diagnosis (all ps < 0.05). CONCLUSIONS The majority of older adults with dementia are either undiagnosed or unaware of the diagnosis, suggesting shortcomings in detection and communication of dementia. Individuals who may benefit from targeted screening include racial/ethnic minorities and persons who have lower educational attainment, any functional impairment, or attend medical visits alone.
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Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA.
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Quincy M Samus
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Vega IE, Cabrera LY, Wygant CM, Velez-Ortiz D, Counts SE. Alzheimer's Disease in the Latino Community: Intersection of Genetics and Social Determinants of Health. J Alzheimers Dis 2018; 58:979-992. [PMID: 28527211 DOI: 10.3233/jad-161261] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) is the most common type of dementia among individuals 65 or older. There are more than 5 million diagnosed cases in the US alone and this number is expected to triple by 2050. Therefore, AD has reached epidemic proportions with significant socioeconomic implications. While aging in general is the greatest risk factor for AD, several additional demographic factors that have contributed to the rise in AD in the US are under study. One such factor is associated with the relatively fast growth of the Latino population. Several reports indicate that AD is more prevalent among blacks and Latinos. However, the reason for AD disparity among different ethnic groups is still poorly understood and highly controversial. The Latino population is composed of different groups based on nationality, namely South and Central America, Mexico, and Caribbean Hispanics. This diversity among the Latino population represents an additional challenge since there are distinct characteristics associated with AD and comorbidities. In this review, we aim to bring attention to the intersection between social determinants of health and genetic factors associated with AD within the Latino community. We argue that understanding the interplay between identified social determinants of health, co-morbidities, and genetic factors could lead to community empowerment and inclusiveness in research and healthcare services, contributing to improved diagnosis and treatment of AD patients. Lastly, we propose that inserting a neuroethics perspective could help understand key challenges that influence healthcare disparities and contribute to increased risk of AD among Latinos.
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Affiliation(s)
- Irving E Vega
- Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Laura Y Cabrera
- Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA
| | - Cassandra M Wygant
- Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | | | - Scott E Counts
- Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Hauenstein Neurosciences Center, Mercy Health Saint Mary's Hospital, Grand Rapids, MI, USA
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Berdai Chaouni S, De Donder L. Invisible realities: Caring for older Moroccan migrants with dementia in Belgium. DEMENTIA 2018; 18:3113-3129. [DOI: 10.1177/1471301218768923] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The number of older Moroccan migrants reaching the age of high risk for dementia is increasing in Belgium. Yet no study has been performed to explore how Moroccan families facing dementia experience and manage the condition. The study employed a qualitative design using semi-structured interviews with 12 informal and 13 formal caregivers to answer this research question. Findings indicate that the experience of dementia includes several invisible realities that challenge the informal and formal caregivers: (1) the invisibility of dementia as a condition; (2) the invisible subtleties of the informal care execution; (3) the invisibility and inaccessibility of care services as explanation for these family’s non-use of available services; and (4) the overlooking of culture, migration and religion as invisible influencers of the overall dementia experience. A better understanding of these hidden realities of migrant older people with dementia and their caregivers could lead to interventions to provide effective and tailored person-centred care that is sensitive to the individual’s life experiences, culture and religious background.
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Ferguson SA, Panos JJ, Sloper D, Varma V. Neurodegenerative Markers are Increased in Postmortem BA21 Tissue from African Americans with Alzheimer's Disease. J Alzheimers Dis 2018; 59:57-66. [PMID: 28582866 DOI: 10.3233/jad-170204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) presents with an earlier onset age and increased symptom severity in African Americans and Hispanics. OBJECTIVE Although the prevalence of plaques and tangles may not exhibit ethnicity-related differences, levels of neurodegenerative proteins have not been described. METHODS Here, levels of five proteins (i.e., S100B, sRAGE, GDNF, Aβ40, and Aβ42) and the Aβ42/Aβ40 ratio were measured in postmortem samples of the middle temporal gyrus (BA21) from age-matched African Americans and Caucasians with AD (n = 6/gender/ethnicity). RESULTS S100B levels were increased 17% in African Americans (p < 0.003) while sRAGE was mildly decreased (p < 0.09). Aβ42 levels were increased 121% in African Americans (p < 0.02), leading to a 493% increase in the Aβ42/Aβ40 ratio (p < 0.002). Analysis of GDNF levels did not indicate any significant effects. There were no significant effects of gender and no significant ethnicity with gender interactions on any analyte. Effect size calculations indicated "medium" to "very large" effects. CONCLUSION S100B is typically elevated in AD cases; however, the increased levels in African Americans here may be indicative of increased severity in specific populations. Increased Aβ42/Aβ40 ratios in the current study are compatible with increased disease severity and might indicate increased AD pathogenesis in African Americans. Overall, these results are compatible with a hypothesis of increased neuroinflammation in African Americans with AD.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
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Burke SL, Rodriguez MJ, Barker W, Greig-Custo MT, Rosselli M, Loewenstein DA, Duara R. Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia. J Int Neuropsychol Soc 2018; 24:176-187. [PMID: 28918757 PMCID: PMC6247416 DOI: 10.1017/s1355617717000820] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity. METHODS Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group. RESULTS Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects. CONCLUSIONS Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018, 24, 176-187).
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Affiliation(s)
- Shanna L. Burke
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida
| | | | - Warren Barker
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
| | - Maria T. Greig-Custo
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
| | - Monica Rosselli
- Department of Psychology, Charles E. Schmidt College of Science, Florida Atlantic University, Davie, Florida
| | - David A. Loewenstein
- Miller School of Medicine, University of Miami and Center on Aging, Miami, Florida
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
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Howell JC, Watts KD, Parker MW, Wu J, Kollhoff A, Wingo TS, Dorbin CD, Qiu D, Hu WT. Race modifies the relationship between cognition and Alzheimer's disease cerebrospinal fluid biomarkers. ALZHEIMERS RESEARCH & THERAPY 2017; 9:88. [PMID: 29096697 PMCID: PMC5668981 DOI: 10.1186/s13195-017-0315-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/16/2017] [Indexed: 01/21/2023]
Abstract
Background African Americans have been reported to have a higher prevalence of Alzheimer’s disease (AD) than Caucasians, but etiology-specific AD biomarkers have not been systematically analyzed in older African Americans. Coexisting cerebrovascular disease may also contribute to this increased prevalence. We hypothesized that cerebrospinal fluid (CSF) biomarkers of amyloid, neurodegeneration, and endothelial dysfunction would differ between older African Americans and Caucasians with normal cognition and cognitive impairment associated with AD. Methods We prospectively recruited 135 older Americans to undergo detailed clinical, neuropsychological, genetic, magnetic resonance imaging (MRI), and CSF analysis from 2013 to 2015 at Emory University (Atlanta, GA, USA). We compared levels of CSF markers for β-amyloid (Aβ42, Aβ40), total and phosphorylated tau (t-tau and p-tau181, respectively), endothelial dysfunction (soluble vascular cell adhesion molecule 1, soluble intercellular adhesion molecule 1), α-synuclein, and neurodegeneration (neurofilament light chain [NfL]), as well as MRI markers, for hippocampal atrophy and cerebrovascular disease (white matter hyperintensity [WMH] volume). Results Sixty-five older African Americans (average age, 69.1 years) and 70 older Caucasians (average age, 70.8 years) were included. After adjusting for demographic variables, AD risk alleles, and cognitive function, older African Americans had lower CSF levels of p-tau181 (difference of 7.4 pg/ml; 95% CI, 3.7–11.2 pg/ml; p < 0.001), t-tau (difference of 23.6 pg/ml; 95% CI, 9.5–37.7; p = 0.001), and Aβ40 (difference of 1.35 ng/ml; 95% CI, 0.29–2.42 ng/ml; p = 0.013) despite similar levels of Aβ42, NfL, WMH volume, and hippocampal volume. Cognitively impaired African Americans also had lower CSF t-tau/Aβ42 (difference of 0.255 per 1-SD change in composite cognition; 95% CI, 0.100–0.409; p = 0.001) and p-tau181/Aβ42 (difference of 0.076 per 1-SD change in composite cognition; 95% CI, 0.031–0.122; p = 0.001). These could not be explained by measured biomarkers of non-AD processes, but African Americans may be more susceptible than Caucasians to the cognitive effects of WMH. Conclusions Despite comparable levels of CSF Aβ42 and Aβ42/Aβ40, cognitive impairment in African Americans is associated with smaller changes in CSF tau markers but greater impact from similar WMH burden than Caucasians. Race-associated differences in CSF tau markers and ratios may lead to underdiagnosis of AD in African Americans. Trial registration ClinicalTrials.gov, NCT02089555. Retrospectively registered on 14 March 2014.
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Affiliation(s)
- Jennifer C Howell
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA.,Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly D Watts
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA.,Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica W Parker
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA.,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Junjie Wu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexander Kollhoff
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA.,Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas S Wingo
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA.,Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Cornelya D Dorbin
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA.,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Deqiang Qiu
- Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA.,Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - William T Hu
- Department of Neurology, Emory University School of Medicine, 615 Michael Street, 505F, Atlanta, GA, 30322, USA. .,Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, USA. .,Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, USA.
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Ramirez Gomez L, Jain FA, D'Orazio LM. Assessment of the Hispanic Cognitively Impaired Elderly Patient. Neurol Clin 2017; 35:207-229. [PMID: 28410657 DOI: 10.1016/j.ncl.2017.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hispanics are the largest minority group in the United States, approximately 7% of the population older than 65. They often encounter challenges related to health care access and quality of care. The prevalence of dementia among Hispanics is higher than that of non-Hispanic whites and they frequently present at a more advanced stage of illness. Cognitive evaluation should take into account sociodemographic information and cultural factors to avoid misdiagnosis and guide management. A provider who has knowledge of Hispanic culture should conduct the neuropsychological assessment, and tests used to measure cognitive functioning should be developed for Hispanics in the United States.
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Affiliation(s)
- Liliana Ramirez Gomez
- Department of Neurology, University of California, San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA.
| | - Felipe A Jain
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA
| | - Lina M D'Orazio
- Department of Neurology, Keck School of Medicine of USC, 1520 San Pablo Street, HCCII, Suite 3000, Los Angeles, CA 90033, USA
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Moon Y, Lee H, Namgung OK, Han SH. Which Stratum of Urban Elderly Is Most Vulnerable for Dementia? J Korean Med Sci 2016; 31:1635-40. [PMID: 27550494 PMCID: PMC4999408 DOI: 10.3346/jkms.2016.31.10.1635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/26/2016] [Indexed: 11/20/2022] Open
Abstract
Many factors associated with a patient's lifestyle may disrupt timely access to dementia diagnosis and management. The aim of this study was to compare characteristics of lifestyle factors at the time of initial evaluation for dementia across degrees of dementia, and to identify risk factors relating to late detection of dementia, in order to understand the various lifestyle barriers to timely recognition of the disease. We reviewed medical records of 1,409 subjects who were diagnosed as dementia among 35,723 inhabitants of Gwangjin-gu. Dementia severity was divided into three degrees. Age, sex, education, income, smoking, heavy drinking, physical activity, religion, and living conditions were evaluated. There was a significantly greater proportion of individuals who were old age, female, less educated, who had never smoked or drank heavily, without physical activity, with no religious activity and living with family other than spouse in the severe dementia group. The lifestyle risks of late detection were old age, lower education, less social interactions, less physical activity or living with family. We can define this group of patients as the vulnerable stratum to dementia evaluation. Health policy or community health services might find ways to better engage patients in this vulnerable stratum to dementia.
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Affiliation(s)
- Yeonsil Moon
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | | | | | - Seol Heui Han
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
- Center for Geriatric Neuroscience Research, Institute of Biomedical Science, Konkuk University, Seoul, Korea.
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Porter CN, Miller MC, Lane M, Cornman C, Sarsour K, Kahle-Wrobleski K. The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study. SAGE Open Med 2016; 4:2050312116661877. [PMID: 27606063 PMCID: PMC4999794 DOI: 10.1177/2050312116661877] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/27/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Behavioral and psychological symptoms of dementia in individuals with Alzheimer's disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case-control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement. METHODS Data from the South Carolina Alzheimer's disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied. RESULTS A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14-1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission. CONCLUSION Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer's disease and caregiver support services are necessary to prevent or delay nursing home admission.
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Affiliation(s)
| | - Margaret C Miller
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Marcia Lane
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Carol Cornman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khaled Sarsour
- Department of Epidemiology, Genentech Incorporated, San Francisco, CA, USA
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Yusufov M, Weyandt LL, Piryatinsky I. Alzheimer's disease and diet: a systematic review. Int J Neurosci 2016; 127:161-175. [DOI: 10.3109/00207454.2016.1155572] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Miryam Yusufov
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Lisa L. Weyandt
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Irene Piryatinsky
- Department of Psychiatry and Human Behavior, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ravenscroft TA, Pottier C, Murray ME, Baker M, Christopher E, Levitch D, Brown PH, Barker W, Duara R, Greig-Custo M, Betancourt A, English M, Sun X, Ertekin-Taner N, Graff-Radford NR, Dickson DW, Rademakers R. The presenilin 1 p.Gly206Ala mutation is a frequent cause of early-onset Alzheimer's disease in Hispanics in Florida. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2016; 5:94-101. [PMID: 27073747 PMCID: PMC4788736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/19/2016] [Indexed: 06/05/2023]
Abstract
Mutations in the gene encoding the presenilin-1 protein (PSEN1) were first discovered to cause Alzheimer's disease (AD) 20 years ago. Since then more than 200 different pathogenic mutations have been reported, including a p.Gly206Ala founder mutation in the Hispanic population. Here we report mutation analysis of known AD genes in a cohort of 27 early-onset (age of onset ≤65, age of death ≤70) Hispanic patients ascertained in Florida. The PSEN1 p.Gly206Ala mutation was identified in 13 out of 27 patients (48.1%), emphasizing the importance of this specific mutation in the etiology of early-onset AD in this population. One other patient carried the known PSEN1 p.Gly378Val mutation. Genotyping of the PSEN1 p.Gly206Ala and p.Gly378Val mutations in 63 late-onset Hispanic AD patients did not identify additional mutation carriers. All p.Gly206Ala mutation carriers shared rare alleles at two microsatellite markers flanking PSEN1 supporting a common founder. This study confirms the p.Gly206Ala variant as a frequent cause of early onset AD in the Hispanic population and for the first time reports the high frequency of this mutation in Hispanics in Florida.
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Affiliation(s)
| | - Cyril Pottier
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
| | - Matt Baker
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
| | | | - Denise Levitch
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
| | - Patricia H Brown
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
| | - Warren Barker
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical CenterMiami Beach, FL, 32224 USA
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical CenterMiami Beach, FL, 32224 USA
| | - Maria Greig-Custo
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical CenterMiami Beach, FL, 32224 USA
| | - Ana Betancourt
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical CenterMiami Beach, FL, 32224 USA
| | - Mara English
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical CenterMiami Beach, FL, 32224 USA
| | - Xiaoyan Sun
- McKnight Brain Institute, Miller School of Medicine, University of MiamiMiami, FL, 32224 USA
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
- Department of Neurology, Mayo ClinicJacksonville, FL, 32224 USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo ClinicJacksonville, FL, 32224 USA
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50
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Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers. Alzheimer Dis Assoc Disord 2016; 29:146-53. [PMID: 25590939 DOI: 10.1097/wad.0000000000000077] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The clinical need to address stress and depression in Latino dementia caregivers (CGs) combined with low health literacy and less accurate knowledge of dementia motivated the development of a pictorial tool [called a fotonovela (FN)] to teach (a) coping skills for caregiver (CG) stress; (b) self-assessment of depression; and (c) encourage improved utilization of available resources. To test the effectiveness of the FN, 110 of 147 Latino CGs, who were randomly assigned to the Fotonovela Condition (FNC) or the Usual Information Condition (UIC), were included in the final analyses. Self-report measures were given at baseline and post intervention. Results showed that FNC CGs demonstrated significantly greater reductions in level of depressive symptoms than UIC CGs. A significant decrease in level of stress due to memory and behavioral problems exhibited by their loved ones was similar in both groups. The FNC CGs reported that the FN was more helpful and that they referred to it more often than the UIC CGs did with regard to the informational materials they were provided about dementia. In conclusion, a culturally tailored FN can be an effective tool for Latino CGs given their high unmet needs for assistance and various barriers in accessing resources.
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