The Silent Epidemic of Alzheimer’s Disease Among African Americans

A Onepeoples.com Staff Report

African-Americans have a higher rate of dementia due to strokes and a lower prevalence of dementia stemming from Parkinson’s Disease than do Caucasians, according to a study by Yale researchers published in the Journal of the American Geriatric Society.

Alzheimer’s disease appears to be more prevalent among African-Americans—with estimates ranging from 14 percent to almost 100 percent higher than the disease’s prevalence among whites—according to a new report* prepared by the Alzheimer’s Association.

In another 10-year study conducted in Indianapolis and Ibadan, Nigeria, has shown that African-Americans are twice as likely as Africans to develop dementia and Alzheimer disease. This is the first report of incidence rate differences for Alzheimer disease and other dementias, contrasting populations from industrialized and non-industrialized countries, using the same group of investigators and identical methodologies. The study was conducted by researchers from the Indiana University School of Medicine and the University of Ibadan and published in the Feb.14 issue of the Journal of the American Medical Association.

Starting with the non-demented subjects from the prevalence study, the researchers conducted the newly published incidence study, which for five years followed 2,147 African-Americans in Indianapolis and 2,459 Yoruba in Ibadan, age 65 and older, to see if they developed dementia and Alzheimer disease. In the African-American group studied, 3.24 percent per year-developed dementia, including 2.52 percent per year who developed Alzheimer disease.

In the African group, 1.35 percent per year developed dementia including 1.15 percent per year who developed Alzheimer disease. The majority of those who developed a dementing disorder, in either country, developed Alzheimer disease. In both communities two-thirds of the study subjects were female.

The environment may be a factor in the development of dementia and Alzheimer’s disease, because rates of those conditions are noticeably different among African-Americans and black populations of the Yoruba of West Africa.

The genetic basis of Alzheimer’s dementia appears to differ between African-Americans and Caucasians, said Sharon Inouye, associate professor of internal medicine and geriatrics at Yale School of Medicine and senior author of the study.

“Alzheimer’s disease is a ‘silent epidemic’ that has slowly invaded the African-American community before most of us were even aware of its symptoms and its impact. These studies are sending us a clear wake-up call”. Now, the epidemic has reached crisis proportions. We must mobilize all of the resources we can find to get it under control before it overwhelms us.

"The presence of a certain gene (apolipoprotein E allele, E-4 allele) is a potent risk factor for Alzheimer’s Disease in Caucasians, but not for African-Americans," she said.

Evidence exists that the incidence of Alzheimer disease (AD), as well as risk attributable to specific genetic factors such as apolipoprotein E (APOE) genotype, may vary considerably among ethnic groups.

Dementia is an acquired persistent impairment of cognitive functioning and is a growing problem for the U.S. population. Currrently, 2.2 million Americans suffer from dementia. An estimated seven million to 10 million Americans will have severe dementia by the year 2040. Recent studies have estimated the total national costs for dementia at more than $67 billion annually.

Not only are racial disparities among those who contract this disease AGE appears to be a factor also. The relationship between hypertension, cholesterol levels and dementia is particularly relevant for elderly African American patients because they are more likely than whites to have hypertension and/or diabetes. (Medicare Beneficiary Survey)

Vascular dementia is associated with vascular disease and stroke and generally occurs in someone who has had multiple strokes. It can mimic the symptoms of Alzheimer’s Disease, and in some cases, a person could be suffering from both forms of dementia.

Inouye also found that cultural and socio-economic biases in cognitive testing may lead to a misdiagnosis of dementia for African-Americans. "Some testing may assume the patient has certain cultural information or information gained through formal education," Inouye said. "For example, a patient might be asked to sequence pictures about an activity with which they are not familiar and may be misdiagnosed as being cognitively impaired."

She said physicians should be attuned to biases in testing and be more aware of factors contributing to vascular dementia when African-American patients come to them for dementia evaluations.

"One size fits all does not work in dementia research," Inouye said. "A certain genetic or causal model may not fit across all ethnicities and we might have to cast a broader point of view."

The other researchers on the study, which was supported in part by a grant from the National Institute on Aging, were Tanya Froehlich, M.D., principal investigator, and Sidney Bogardus, assistant professor of internal medicine and geriatrics and medical director of the Adler Geriatrics Assessment Center.

At OHSU there is research being done in the area of Alzheimer’s research with African Americans. The stated goals of the African American Dementia and Aging Project (AADAPt) is to “establish 100 African-American seniors residing in the Portland/Vancouver Metropolitan area who will undergo regular follow-up assessments in order to determine the incidence and specific risk factors for age-related problems related to memory loss.” This valued research is being conducted by Fred C. Miller, MS - Director, African American Dementia and Aging Project (AADAPt), along with his research assistant Farhia Omar. This brother states his purpose as being research in “investigating various risk factors for dementia in African Americans. These potential causative risk factors revolve around three areas. The first area involves various physiological factors such as high blood pressure, thyroid levels and various structures in the brain. The second involve various environmental factors such as stress and diet and the third area involves genetic risk factors associated with memory problems. This research will provide needed information to better understand with-in differences that impacts African Americans with memory problems.”

The Education and Information Transfer Core of the Layton Aging & Alzheimer’s Disease Center develops and carries out a range of education programs to increase awareness and understanding of Alzheimer’s Disease research, aid in the recruitment of subjects for Center studies, and improve care and quality of life for persons with dementia and their family caregivers.

Activities include the training of professionals, seminars, lectures, and workshops for families and professionals; outreach to community organizations and groups to publicize research; and collaboration with other organizations that serve patients and families, e.g., state and local agencies that serve the elderly and the Alzheimer’s Association. A newsletter, Alzheimer’s Update, is published twice per year.

Research highlighted in the Alzheimer’s Association report suggests that:

The prevalence, incidence, and cumulative risk of Alzheimer’s disease appear to be much higher in African-Americans.

· Age-specific prevalence of dementia has been found to be 14 percent to 100 percent higher in African-Americans. (While the rates vary among studies, three out of four report these higher prevalence rates.)

· Among African-Americans, the cumulative risk of dementia among first-degree relatives of persons with Alzheimer’s disease is 43.7 percent.

· For spouses (who share environmental but not genetic backgrounds), the cumulative risk is 18.4 percent. These findings, reported in January 2002, are based on family histories of the largest number of African-American families ever studied for Alzheimer’s disease.

The number of African-Americans entering age of risk (65 and older) is growing rapidly.

· Age is a key risk factor for Alzheimer’s disease in all racial and ethnic groups. Over 10 percent of all persons over 65, and nearly half of those over 85 have Alzheimer’s disease.

· The number of African-Americans age 65 and over will more than double by 2030, from 2.7 million in 1995 to 6.9 million by 2030.

· The number of African-Americans age 85 and over is growing almost as rapidly, from 277,000 in 1995 to 638,000 in 2030, and will increase more than fivefold between 1995 and 2050 when it will reach 1.6 million.
Genetic and environmental risk factors for Alzheimer’s disease seem different in African-Americans but have not been well studied.

· Genetic risk factors seem different in African-Americans and white Americans. APOE genotype alone does not explain the increased frequency of Alzheimer’s disease in older African-Americans.

· Vascular disease may be a particularly powerful factor in the prevalence of Alzheimer’s among African-Americans.

o Data from a large-scale longitudinal study indicate that persons with a history of either high blood pressure or high cholesterol levels have been found twice as likely to get Alzheimer’s disease. Those with both risk factors are four times as likely to become demented.

o Sixty-five percent of African-American Medicare beneficiaries have hypertension, compared to 51 percent of white beneficiaries. They are also at higher risk of stroke.

o African-Americans have a 60 percent higher risk of type 2 diabetes—a condition that contributes directly to vascular disease.

o African-Americans have a higher rate of vascular dementia than white Americans.

Screening and assessment tools and clinical trials are not designed to address the unique presentation of Alzheimer’s disease in African-Americans.

· Ethnic and cultural bias in current screening and assessment tools is well documented; as a result, African-Americans who are evaluated have a much higher rate of false-positive results. At the same time, there is substantial evidence of underreporting of dementia among African-Americans.

· African-Americans tend to be diagnosed at a later stage of Alzheimer’s disease—limiting the effectiveness of treatments that depend upon early intervention.

· African-Americans are seriously underrepresented in current clinical trials of potential treatments for Alzheimer’s disease—particularly in trials conducted by drug companies —even though evidence of genetic differences and response to drugs varies significantly by race and ethnicity.

Report: African-Americans and Alzheimer's Disease: The Silent Epidemic
*To view the report you must have Adobe Acrobat Reader® . To download Adobe Acrobat Reader® click here.

Preventative Measures:

5 TIPS TO BUILD AND MAINTAIN A HEALTHY BRAIN
Here are some practical tips designed balance your life and building your brainpower. These techniques can help keep our brain flexible and resilient as you age.

EXERCISE YOUR BRAIN AND HAVE FUN.
A recent study 1 examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. The results of their study suggested that levels of participation in cognitive stimulating activities such as playing board games (e.g.chess or checkers), playing bridge, playing a musical instrument, dancing, reading or writing was associated with a reduced risk of dementia over a 5 year follow-up period. Cross word puzzles have also been recommended help keep your mind sharp and active.

So break out that chessboard or better yet learn to dance salsa or tango.

1 Leisure activities and the risk of dementia in the elderly. Verghese J, Lipton RB, Katz MJ et al. N Engl J Med. 2003 Jun 19; 348(25): 2508-16.

EAT WELL
Eat cold-water fish (e.g. salmon, tuna, mackerel), which contain lots of omega-3 fatty acids 2-3 times per week

Eat lots of fresh foods and vegetables, particularly foods like blueberries rich in antioxidants.

COMBAT DEPRESSION
Antidepressant medications and psychotherapy are effective treatments for serious bouts of depression. Many people who develop dementia had a prior episode of serious depression.

Regular exercise and social activities such as volunteering can improve energy levels, reduce stress, boost self-esteem and combat milder forms of depression.

REDUCE STRESS
Research indicates that stress produces elevated levels of the hormone cortisol. Elevated cortisol levels kills brain cells, particularly brain cells associated with memory functions.

To reduce stress set aside time to relax and unwind. Consider using relaxation techniques, meditation or prayer

GET OFF THE COUCH AND KEEP MOVING
Regular exercise and attention to physical fitness has dramatic effects on chronic illnesses, stress reduction, a sense of well-being and may combat loss of brain function as we age. A recent study 2 reports robust declines in brain tissue densities as a function of age in the frontal, parietal, and temporal cortices among subjects who engaged in regular aerobic activities. The authors we found that losses in these areas were substantially reduced as a function of cardiovascular fitness, even when we statistically controlled for other moderator variables. These findings extend the scope of beneficial effects of aerobic exercise beyond cardiovascular health, and they suggest a strong solid biological basis for the benefits of exercise on the brain health of older adults.

So everyone should engage in at least 15 minutes of aerobic activity (e.g. walk, run, swim) at least three times per week.

2Aerobic fitness reduces brain tissue loss in aging humans. Colcombe SJ, Erickson KI, Raz N et al. J Gerontol A Biol Sci Med Sci. 2003 Feb; 58(2): 176-80.

LOSE THE STRESS
Stress takes a terrible toll on our bodies and our spirits. Extended exposure to stressful environment causes elevations in a hormone called cortisol. Elevated cortisol levels kill brain cells, particularly cells in the area of the brain called the hippocampus, which is responsible for memory.

Try music, meditation, massage and most of all simplifying your life. These changes can have important benefits for your mental health and Stress cause

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