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Proportionally, minorities are more likely than whites to have Alzheimer’s disease or other dementias in the United States. African Americans are two times more likely than non-Hispanic whites to be affected and Hispanics are 1.5 times more likely. These persistent disparities are not fully understood, though genetics, lifestyle, and other factors have been studied. “Unfortunately I don’t think there’s a clear answer,” said Dana Alliance member Patrick Griffith, M.D., F.A.A.N. “It’s probably multi-factorial.” April is Minority Health Month, so I called Griffith earlier this week to get his insight. He is the retired chief of neurology and professor of clinical medicine at the Morehouse School of Medicine in Atlanta, and has spoken at several of Dana’s Staying Sharp events, from New York to California.
Griffith’s advice for…
Caregivers: If a loved one is having memory or other cognitive problems, take them to a physician to get tested. Do not simply disregard their problems by blaming it on old age and assume nothing can be done. “Memory loss is never normal,” Griffith said. Also keep an eye on changes in judgment, behavior, and visual-spatial issues. “There are a lot of centenarians who are perfectly intact mentally.”
Relatives: If you’re a relative of someone who’s been diagnosed with Alzheimer’s, you should get tested to see if you’re at risk. The two major risk factors are age and family history. “But make sure the family history is accurate,” Griffith said. The purpose of getting tested is both to exclude diseases that mimic dementia (like depression or medication-related delirium) as well as other forms of non-Alzheimer’s diseases (like fronto-temporal dementia) and confirm the clinical diagnosis of probable Alzheimer’s Disease. Once confirmed, patients and their families can choose enrollment in clinical trials for AD chemotherapy, aggressive early treatment with FDA approved AD drugs, and getting personal affairs in order (wills, guardianships, long term care insurance etc.).
Faith leaders: The Staying Sharp events in Mount Vernon and Oakland both took place at churches. Griffith believes places of worship are great for getting the word out to the African American community because, in addition to seeking out physicians, people turn to faith leaders for advice. “It is up to these faith leaders to inform their congregation that cognitive problems are not some form of religious punishment” but rather a medical condition that warrants a trip to the doctor.
Little is clear when it comes to factors causing the higher Alzheimer’s prevalence in certain minorities. We do know that African Americans are more likely than whites to be diagnosed with diabetes, as are Hispanics, and are also at higher risk for hypertension. Dr. Griffith works in the “Stroke Belt,” an area in the Southeastern United States and Mississippi Valley given its name for its high rate of stroke-related deaths. One study found that African Americans living in the Stroke Belt have a higher incidence of cognitive impairment. It may be that African Americans with Alzheimer’s have a form of the disease that’s being driven by vascular risk factors, according to Griffith.
Lifestyle and environment also matter, though Griffith admits these are broad and poorly understood entities. Diet and physical exercise may contribute to the difference in incidence and prevalence of Alzheimer’s between native Africans and African Americans, but this still would not explain why, in developed countries, African Americans have a higher rate than white people. “There are a lot of pieces to the puzzle, but no clear answer,” Griffith said. “Nobody has a cogent explanation for what is causing the demographic disparity.”
The situation is far from hopeless, however. As Griffith and others preach during Staying Sharp events, the four keys to maintaining cognitive function are social, mental, and physical activity, along with eating well which, therefore, would control vascular risk factors. Especially in those who don’t have a genetic form of Alzheimer’s, it “must be some combination of vascular risk factors that is causing it. The hope is that you can modify those. It may optimistic but in the current state of science that’s all we have.”
There are a lot of unknowns when it comes to Alzheimer’s. Griffith spoke about the hope that research will one day lead to a cure or at least a way to manage it better. In the meantime, it is important to delay or prevent the symptoms as best you can. “You’ve got to try to stay sharp because that’s the best strategy while we’re living in this uncertain time.”