Alzheimer's rates expected to climb among minority elderly
■ Health care disparities and low minority enrollment in clinical trials interfere with crafting solid treatment plans for blacks and other minorities.
By Susan J. Landers — Posted April 28, 2008
Washington -- As research findings coalesce around a collection of risk factors for Alzheimer's disease, it is becoming obvious that poor and minority populations -- the ones most likely to harbor risk factors such as hypertension and diabetes --also are more likely than whites to encounter this brain disorder.
The age-specific prevalence of dementia already has been estimated to be from 14% to as much as 100% higher in blacks than in whites by the Alzheimer's Assn., an advocacy and educational group based in Chicago. And the disease is expected to surge among Hispanics in the coming years. Currently, about 200,000 Hispanics in the U.S. have Alzheimer's. That number could climb to 1.3 million by 2050, according to the association.
Cardiovascular disease, high cholesterol levels, hypertension, obesity, diabetes and fewer years of education all are factors that may increase an individual's risk for Alzheimer's disease, and minorities are overrepresented in all of these factors.
Since there is unlikely to be a cure for dementia anytime soon, a Plan B for addressing the needs of this group of aging, at-risk minorities was offered at the Annual Conference of the National Council on Aging and the American Society on Aging, held March 26-30 in Washington, D.C.
Presented by Richard E. Powers, MD, a geriatric psychiatrist and medical director of the Alabama Dept. of Mental Health and Mental Retardation in Tuscaloosa, the approach covers the reduction of risk factors, early recognition of disease, aggressive therapy, caregiver support and research. Dr. Powers also is the chair of the Medical Advisory Board of the Alzheimer's Foundation of America, a national, nonprofit organization founded in 2002 and based in New York City.
The fact that few members of minority groups are enrolled in clinical trials to examine the links between risk factors and cognitive decline can lead to treatment complications, Dr. Powers noted. That has to change, he stressed.
"We need to be able to show an African-American that if you don't take your antihypertensive when you are 50, you will end up like your father -- who had terrible dementia -- when you are 70 or 80."
Effects of disparities
Well-documented disparities in the health care provided to African-Americans also make it less likely that existing conditions, such as hypertension and diabetes, will be addressed adequately, he said. "All benchmarks find African-Americans trail the rest of the population."
The elimination of such disparities has been a major focus of several groups in recent years, including the Institute of Medicine, which in 2002 released its report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care." In addition, in 2004 the AMA, the National Medical Assn. and the National Hispanic Medical Assn. launched a Commission to End Health Care Disparities. More than 60 other health groups have now joined this effort.
Another roadblock that might discourage blacks and other minority group members from joining research studies is the lingering distrust of the medical system generated by the infamous Tuskegee syphilis study, Dr. Powers said. In that study, the course of the untreated disease was charted for 40 years among poor, black men until the study was halted in 1972.
Many members of minority communities also believe that dementia's progress is a natural part of aging, so they don't see the need to study it, Dr. Powers said. "We have work to do" to correct these impressions, he added.
A first step could be a discussion on dementia between concerned patients and primary care physicians. But the subject doesn't often come up, according to surveys conducted by the Alzheimer's foundation. Dr. Powers called this lack of communication "a malfunction in the system."
Such a discussion could reveal a treatable problem that can affect memory, such as sleep apnea, vitamin B12 deficiency, thyroid disease or the effect of drugs like benzodiazepines, Dr, Powers said. "Yet thousands of people are sitting home thinking they have a problem."
Dementia screening, which the Alzheimer's foundation supports, remains controversial, with opponents saying the risk for false-positives is too high to warrant widespread testing, and the stigma of a positive test would prove a deterrent to those with memory concerns.
But the foundation views screenings as an educational opportunity, allowing physicians and others to say, "Here's what you can do to hang onto that precious intellect," Dr. Powers said.
Broad, systemic changes are required to address the needs of a growing group of elderly patients at risk for dementia adequately, Dr. Powers said. "The system now serves no one the way we want it to. African-Americans and other minorities need to be included."