Alzheimer’s in the Black and African American Community
Black and African Americans are twice as likely as non-Hispanic white Americans to have Alzheimer’s disease or a related dementia, higher than any other ethnic or racial group in the US. Several factors may contribute to this disparity, including disproportionate prevalence of certain medical conditions associated with dementia risk (high blood pressure, diabetes, heart disease), genetic factors, lifestyle habits (diet, physical activity), cultural influences, environmental factors (pollution, neighborhood resources), and/or social determinants of health (educational opportunity, access to quality healthcare, discrimination, chronic stress).
Despite being at higher risk, Black and African Americans typically do not seek medical attention when symptoms of memory loss first appear. Generational, cultural, and/or social factors may also contribute to this observation, but whatever the reason, delaying a diagnosis of Alzheimer’s disease or a related dementia can contribute to worsening of other health problems, such as forgetting to take medications or paying less attention to self-care. Delayed diagnosis also runs the risk of missing the window of opportunity when treatments for memory loss may be most effective.
CAREGIVER IMPACT
Black and African Americans who provide care to family members with Alzheimer's disease or related dementias often experience hardships, including higher levels of stress and depression, and poorer levels of self-care and overall health status. Those living in underserved communities often have limited awareness of and/or access to caregiver resources such as support groups or respite care. When available, traditional support services and resources may not be culturally tailored to meet the specific needs of the Black and African American community. Families who cannot afford to pay for caregiving may lose wages by cutting their own work hours to manage caregiving responsibilities. This may be especially difficult on younger generations (adult children/grandchildren) who may have to delay their career goals/advancement during prime working years.
ECONOMIC IMPACT
In addition to lost income, Black and African American community members are disproportionately impacted by healthcare costs of Alzheimer’s disease and related dementias. Chronic health conditions such as hypertension, diabetes, and cardiovascular disease, which are more prevalent among Black/African Americans, can complicate dementia healthcare needs and increase medical costs. Delays in seeking a diagnosis also contributes to higher costs because, as the disease progresses without early intervention, the frequency and complexity of health crises increase and lead to more costly hospitalizations, emergency care, and skilled nursing interventions.
How Black and African American Participation in Dementia Research Has Benefitted the Community
Black and African Americans who have participated in dementia research at Mayo Clinic Florida have helped the community, their loved ones, and future generations by contributing to important discoveries in the understanding and treatment of Alzheimer’s disease and related dementias.
Response to Dementia Medications
Our investigators have identified genetic and biological differences between racial and ethnic groups that may influence how medications for dementia work. Certain genetic variations, for example, are more common in Black populations. These variations may affect how the body uses and breaks down dementia medications, which could impact their effectiveness and side effects. More focused research is needed; however, Black individuals have historically been underrepresented in Alzheimer clinical trials. This lack of diverse representation has made it harder to directly compare how different groups respond to medications used in Alzheimer's treatment.
Impact of Vascular Disease
A Mayo Clinic study suggests that vascular disease may have a greater impact on memory and thinking in Black and African Americans, potentially leading to faster cognitive decline. Disparities in access to healthcare, lifestyle factors, and social determinants of health might exacerbate the effects of vascular disease on the brain in this population.
Vitamin Deficiency in Memory Decline
Certain vitamin deficiencies, including B12 and D, have been linked to cognitive decline and memory problems in general. A study by Mayo Clinic investigators, however, found that Black and African Americans may be more prone to these deficiencies, potentially related to dietary habits or lack of sunlight exposure. These deficiencies may contribute to greater cognitive decline compared to other groups.
Depression and Memory
Depression is a well-known risk factor for cognitive decline and dementia. In one study by Mayo Clinic investigators, however, memory and thinking abilities in older Black and African Americans with depression declined significantly faster than White participants with depression. The researchers noted that fewer Black participants with depression reported being treated with antidepressant medications as compared to White participants with depression. The reason for this discrepancy warrants further study and may reflect differences in cultural attitudes and beliefs towards mental health issues, access to mental health resources, and/or willingness to seek help.
Fair and Accurate Cognitive Evaluations
Cognitive tests are used to measure things like memory and thinking abilities, and are important tools to detect changes associated with early Alzheimer’s disease. Most cognitive tests were developed in non-Hispanic White populations, and their use in older Black Americans consistently led to incorrect conclusions and diagnoses. To address this problem, over 300 members of the Jacksonville Black and African American community volunteered to participate in a Mayo Clinic ADRC study that led to new guidelines for the interpretation of cognitive test results. Mayo’s Older African Americans Normative Studies improved our understanding of how aging affects memory and thinking abilities and have been implemented across the country to ensure fair cognitive testing to improve diagnosis, care, and quality of life.
LEARN MORE
- AfricanAmericansAgainstAlzheimer’s is the nation’s first organization dedicated to building a coordinated national response to Alzheimer’s disease among African Americans.
- The African American Alzheimer's Caregiver Training and Support (ACTS 2) project provides free, telephone-based support to African-American Alzheimer’s caregivers.