The Disproportionate Impact of Dementia on Minorities

A look at the inequalities faced by minorities when it comes to dementia.

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By the year 2060, the number of Alzheimer’s disease cases in the U.S. is predicted to increase to about 14 million with the largest increase being seen in Hispanic and African Americans. Alzheimer’s cases in Hispanic people are predicted to increase to seven times what they are today and African American cases are predicted to increase to four times today’s numbers. “Among people ages 65 and older, African Americans have the highest prevalence of Alzheimer’s disease and related dementias (13.8%), followed by Hispanics (12.2%), non-Hispanic whites (10.3%), American Indian and Alaska Natives (9.1%), and Asian and Pacific Islanders (8.4%)” (CDC, 2018). Let’s examine what may be responsible for the disparity in dementia and Alzheimer’s disease cases amongst different races.

Even though the disproportionate impact of Alzheimer’s on people of colour is still being studied, what we do know is that risk factors for Alzheimer’s disease like diabetes and hypertension are more common in communities of colour. Additionally, a genetic risk factor for Alzheimer’s is APOE4. Several studies suggest that this is more prevalent in African Americans than in Caucasians; however, it is unclear whether APOE4 increases the risk of Alzheimer’s disease in African Americans because studies have shown opposing results. Many people are under the impression that dementia cannot be prevented; however, this is a misconception. Aside from the things that we do not have control over like genetics and aging, studies have shown that dementia can be prevented through healthy eating, adequate sleep, and regular exercise. Because of lack of access to resources, not everyone is easily able to make these lifestyle changes.

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Access to resources like safe and affordable housing, education, public safety, healthy foods, and emergency/healthcare services can have a huge impact on general health outcome. Studies have shown that different socioeconomic factors affect brain health, which increases the risk of dementia. Dementia is more prevalent and occurs 10 years earlier in low and middle income countries than in high income countries due to lack of access to education and leisure activities, poor nutrition and lack of access to healthy foods, poor living conditions, and stress (Resende, Guerra, Miller, 2019). It has also been found that individuals who lived in poorer neighbourhoods where education levels were low, unemployment was high, and public assistance was common, had poorer sleep quality and experienced the greatest cognitive decline over time. Interestingly, people who lived in high socioeconomic status neighbourhoods had the highest cognitive function, regardless of reported sleep quality (Hunter et. al, 2018). Unfortunately, minority populations are also underrepresented in Alzheimer’s disease studies so we know relatively little about how Alzheimer’s affects these populations.

Furthermore, different cultural beliefs about dementia can impact how elderly individuals are viewed in their community, as well as the treatment or care they receive. “A complex combination of social and cultural factors also contributes to delayed diagnosis and care of AD in minority populations. Some of these influences include differences in perceptions about normal and abnormal aging, lack of adequate access to medical care, and issues of trust between minority groups and the medical establishment” (Chin, Negash, Hamilton, 2012).

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Providing minority populations with better access to resources is extremely important in order to prevent dementia and Alzheimer’s disease. Increasing diversity in clinical trials is also another step towards inclusivity. The Alzheimer’s Society is trying to make a change and grow their advisory group to include a minimum of 30% BIPOC. They are also trying to make sure that physicians are better equipped to support all Canadians living with dementia by conducting a national survey to identify the experiences of people living with dementia, especially BIPOC communities. These are just a few of the ways that we, as a society, are aiming to be more inclusive and fight the disproportionate impact of dementia and Alzheimer’s on minorities. The first step is to start at the community level and be proactive rather than reactive!

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References:

Charvat, M. (2020, June 29). Why are Minorities Disproportionately Impacted by Dementia? Psychology Today. https://www.psychologytoday.com/ca/blog/the-fifth-vital-sign/202006/why-are-minorities-disproportionately-impacted-dementia.

Centers for Disease Control and Prevention. (2018, September 20). U.S. burden of Alzheimer’s disease, related dementias to double by 2060. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2018/p0920-alzheimers-burden-double-2060.html.

Centers for Disease Control and Prevention. (2019, August 20). The Truth About Aging and Dementia. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/Alz-Greater-Risk.html.

Chin, A. L., Negash, S., & Hamilton, R. (2011). Diversity and Disparity in Dementia. Alzheimer Disease & Associated Disorders, 25(3), 187–195. https://doi.org/10.1097/wad.0b013e318211c6c9

Race and dementia. Alzheimer Society of Canada. (n.d.). https://alzheimer.ca/en/take-action/change-minds/race-dementia.

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