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DEMENTIA IN THE AFRICAN AMERICAN COMMUNITY©
by Virginia H. Templeton, M.D.
October 2005
"To deny diversity is to deny life- with all its richness and manifold opportunities." — Gene Griessman, 1993.
Increased attention is being focused on the risk African Americans face of developing Alzheimer's disease. In a report compiled by the Alzheimer's Association in February 2002, concern was raised that African Americans may be at much higher risk of the disease than their Caucasian counterparts with estimates of disease prevalence ranging from 14 to 100 percent higher in the African American community (three of four reports noted the higher prevalence rate). The financial and emotional impact of this disease on families and communities cannot be underestimated.
While risk factors for dementia in the Caucasian community such as age, diabetes, family history, female gender, and the Apolipoprotein E4 have been well established, the specific risk factors in other racial or ethnic groups are less clear. Age and vascular diseases such as high blood pressure, high cholesterol, and diabetes seem to be important risk factors in the African American community and may contribute to vascular dementia as well as Alzheimer's disease. According to Medicare data, high blood pressure affects 65% of Black beneficiaries as opposed to 51% of Whites and African Americans have a 60% higher risk of developing type II diabetes. These health problems likely contribute to the problem and can be treated, if identified.
It should be noted that African Americans, as a group, represent a wide range of people. In addition to those of African descent, there are people from Haiti, Jamaica, the West Indies, Cuba, the Dominican Republic, and others. There is also immense diversity in educational, economic, and geographic backgrounds. Some older African Americans have had fewer opportunities to have a formal education which is in itself a risk factor for Alzheimer's disease and other dementias and can affect performance on cognitive testing.
Several other issues can confound this discussion and should be mentioned. Generally, dementia is underreported in the African American community. Whether this is related to mistrust of the medical community, lack of access to medical care, poor diagnostic tools, cultural beliefs about memory loss and aging, stigma associated with memory problems, or other causes is unclear. But understanding why this disparity exists is important so that all people can have the best care possible.
In the African American community, Alzheimer's disease is sometimes referred to as a "silent" epidemic because it is so common and because there is often little or no communication with the medical community. There is a great need for more research to understand differences in risk factors, create culturally sensitive cognitive testing, and to address racial disparities that continue to affect diagnosis, treatments, and disease burden in the African American community. Historical injustices cannot be undone but we can go forward in steps and at times leaps to try and improve our knowledge and care given.
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Web resources for information about dementia in the African American community:
Alzheimer's Association - www.alz.org
Ethnic Elders Care Network - www.ethnicelderscare.net
SOURCES used for this paper:
JAMA, January 16, 2002 Vol. 287, No. 3:329-336
Alzheimer's Association website (www.alz.org) > statistics
Ethnic Elders Care Network website (www.ethnicelderscare.net).
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