Study Finds Significant Differences in Dementia Based on Race and Ethnicity

Dementia and its associated diseases impact millions of older adults and their communities across the United States, but it's unclear why some people are more impacted than others. A new study found that Black and Hispanic seniors may be at greater risk of dementia than older individuals of American Indian or Alaska Native, Asian, or white backgrounds.

This research was based on information analysis from a national cohort of older veterans who received care at the Veterans Health Administration (VHA) and included 5 racial and ethnic groups in the country.

These findings highlight the importance of addressing health disparities among equity-seeking groups since most adults are expected to grow old, and may be at risk of dementia in the future.

Understanding the Research

This study was based on a retrospective analysis of information from 1,869,090 participants, of which, 0.4% were American Indian/Alaska Native, 0.5% were Asian, 9.5% were Black, 1% were Hispanic, and 88.6% were white, from which, 13% received a diagnosis of dementia.

The incidence of dementia, when compared with white veterans, was at a ratio of 1.05 for American Indian/Alaska Native participants, 1.20 for Asian veterans, 1.54 for Black participants, and 1.92 for Hispanic veterans.

A limitation of this study is the small sample size in terms of inclusion of women, especially as they have a higher rate of dementia than men.

Early Screening for Dementia is Crucial

Behavioral health medical director at Community Health of South Florida Inc., psychiatrist Howard Pratt, DO, says, “The study is thorough in that it sampled nearly two million people over a two-year span only to reveal the importance of access to healthcare and of healthcare literacy."

Dr. Pratt explains, “Regardless of your race and cultural background, you need to be aware that all groups are at risk for dementia. One’s own quality of life as well as the quality of life for one’s family and close ones will be improved with early diagnosis.”

Since dementia limits the ability to create and retain new memories, Dr. Pratt notes that symptoms are usually noticed by others before the person suffering from this memory loss accepts it as fact. "People with dementia will typically retreat to old memories to fill in the blanks and these symptoms may wax and wane with time,” he says.

Dr. Pratt highlights, “It’s also very important to understand the risk factors for dementia, including hypertension, diabetes, obesity, stroke, transient ischemic attack, post-traumatic stress disorder, traumatic brain injury and alcohol use disorders. Neglecting the treatment of these conditions puts you at significantly higher risk for dementia."

This research confirms what is already known, as Dr. Pratt notes that racial and ethnic minorities have higher rates of dementia and poorer outcomes, as they do for most health conditions. "However, that is largely due to lack of early access to healthcare and healthcare literacy,” he says.

Dr. Pratt explains, “Dementia calls into question our sharpest tool, which is our brain. For most adults, it is difficult to accept that the organ they rely on for just about anything is not what it used to be."

When memory loss is first pointed out, Dr. Pratt highlights that it may be met with denial, but if memory loss is noticed, it is important to get tested, as screening for dementia is simple. "It’s just about asking a few questions and there are no tricks to the test,” he says.

There are some conditions that may look like dementia, as Dr. Pratt notes pseudodementia, delirium, infections, sleep apnea, and secondary effects of medications. "When there are any symptoms of memory loss, it’s important that one is evaluated to determine the cause,” he says.

In his practice, Dr. Pratt has had the pleasure of treating several people who have dementia, but went on to improve their quality of life after being diagnosed. "With the acceptance of their diagnosis, fears of vulnerability faded, and quality of life improved,” he says.

Trauma Increases Risk of Dementia

Social worker with Mindpath Health, Kiana Shelton, LCSW, says, "This publication fits within a greater body of research regarding not only access to medical care, but the nature of that medical care, especially for individuals from the BIPOC community." 

Shelton highlights that it would be interesting to know if the earlier duties of the veterans who were diagnosed with dementia included combat training. "I wish the public would better understand the link between education and cognitive testing," she says.

Having worked with veterans and those within the geriatric community, Shelton notes the impact of trauma and its correlation with dementia or dementia-like symptoms. "For those working with individuals of BIPOC communities, it means being mindful of the bias within testing," she says.

Dementia Requires Greater Public Attention

Neuropsychologist and director of neuropsychology for the Pacific Neuroscience Institute at Providence Saint John’s Health Center, Stella Panos, PhD, says, "The authors of this study discussed several factors that may influence these findings, including socioeconomic and other structural factors, health effects of racism, other social determinants of health, and decreased cognitive reserve because of unequal access to educational opportunities or quality." 

Panos highlights, "Awareness that these differences are present is crucial, as is more support (e.g., research) to better address these differences. This adds to a growing body of health disparities research in dementia." 

In terms of context, Panos notes that some have begun referring to "a dementia crisis” as the number of cases of dementia is predicted to more than triple by 2050, which will have significant implications for society, especially among individuals from ethnic and racial minority groups. 

Individuals from ethnic and racial minority groups are often under-represented in clinical trials, which can threaten generalizability of findings, according to Panos. "This is an important area of work that needs more attention and support," she says.  

Panos highlights, "While there is no cure for neurodegenerative illnesses such as Alzheimer’s disease, we know that there are many benefits to early assessment, diagnosis, and treatment."