The High Risk of Dementia for African Americans

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African Americans face a higher risk of dementia than any other ethnic group in the United States. Of note, the Alzheimer's Association reports that that the African American dementia risk is approximately twice that of non-Latino whites and 65 percent higher than that of Asian Americans. Other sources state that the risk for African Americans is even up to three times higher than non-Latino whites.

Several researchers have been looking at these inequalities to learn what factors may be contributing to this risk for Alzheimer's and other types of dementia.

Identified Risks

When there are ethnic disparities in risk for any health condition, it's important to learn why those differences are present. Research has found that the following factors are possible contributors to an increased dementia risk for African Americans:

  • Cardiovascular Disease

Cardiovascular disease has been strongly tied to an increased risk of dementia, including Alzheimer's and vascular dementia. Cardiovascular disease includes health issues such as high blood pressure and strokes.

High blood pressure is more common in African Americans than other ethnic groups, and it also develops earlier in life on average. High blood pressure has independently been associated with a higher risk of developing dementia.

The risk of stroke is higher for African Americans than for other ethnic groups as well.

In fact, the National Stroke Association estimates the stroke risk for African Americans is twice as high as for non-Latino whites. Depending on the location and degree of the stroke, vascular dementia may develop as a result.

  • Financial Insecurity

Lower income levels and perceived financial hardship have been correlated with lower cognitive functioning.

One study looking at poverty and perceived financial difficulties involved participants who were approximately 50 years old. Researchers found that individuals who experienced sustained poverty for over 20 years performed lower on cognitive assessment tests. The participants in this study were highly educated, suggesting that it's unlikely that a reverse causation was present. In other words, their higher level of education greatly reduces the chance that lower education levels or lower intelligence actually caused the poverty to develop.

African Americans are at a higher risk for poverty than other ethnic groups, with US Census information showing that almost one quarter of African Americans live in poverty, while less than 10 percent of non-Latino whites live in poverty.

  • Diabetes

The risk of diabetes, which has been associated with an increased risk for Alzheimer's disease, is significantly higher in African Americans than other ethnic groups. Alzheimer's disease has been nicknamed "type 3 diabetes" due to the connection between the two diseases.

  • Lower Education Levels

Lower levels of education present a significant risk for the development of dementia, while higher education levels are thought to reduce dementia risk, in part related to an increase in cognitive reserve.

Currently, African Americans, on average, tend to have lower levels of education than do non-Latino whites. When the history of our country is reviewed, it is noted that our system prevented many African Americans from access to the same educational systems that others attended. As recently as the 1960s, schooling was separate for African Americans, and funding for that schooling was less than for white schools. Prior to this time period, access to equal educational opportunities was even less. Systemically, our country prevented equal access to education, likely contributing to an overall lower educational level, which is associated with an increased dementia risk.

  • Exposure to Lifetime Stressful Experiences

One study presented at the 2017 Alzheimer's Association International Conference found that stressful life experiences for African Americans were correlated with reduced cognitive performance in later life. In this study, stressful life experiences included the following:

  • Being fired from a job
  • Legal and justice system problems
  • Lack of financial security
  • Conflicts with others
  • Emotional and physical trauma
  • Health problems
  • Experiencing combat
  • Having a parent who abused drugs or alcohol
  • The death of a child

The researchers noted that the level of education, APOEε4 gene status (a gene that places people at a greater risk of dementia) and average age were approximately the same across race in the study's participants, and thus were not factors in influencing the outcomes of the study.

On average, African Americans in the study experienced approximately 60 percent more stressful events in their lifetime when compared to non-Latino whites. These events were correlated with decreased cognitive functioning in later life as evidenced by poorer performance on memory and problem-solving tests. For African Americans, each stressful life experience was equivalent to four years of cognitive aging.

It's important to note that this study didn't make the correlation between a specific dementia diagnosis but rather focused on cognitive performance, which can be evidence of, and/or risk for, mild cognitive impairment and dementia.

  • Birth in a State With High Infant Mortality Rates

Another study presented at the 2017 Alzheimer's Association International Conference highlighted the importance of a person's birthplace. The researchers studied the infant mortality rates of different states in 1928. After cross-referencing these rates with medical records, they found that African Americans born in states with high infant mortality rates were 40 percent more likely to develop dementia than African Americans born in low infant mortality states. They were 80 percent more likely to develop dementia when compared to whites born in lower infant mortality states. Whites born in high infant mortality states did not demonstrate an increased risk of dementia, suggesting that they were somehow "immune" to the risks or effects of the mortality rates.

While one study doesn't solidify this correlation, the researchers noted that the increased risk existed even after considering diabetes, stroke, weight, education levels, and high blood pressure. They theorized that harsher conditions in early life may increase dementia risk later in life.

  • Stress

Multiple studies have found that exposure to chronic stress may increase the risk of cognitive impairment. Research found that African Americans are 20 percent more likely to experience psychological distress than non-Latino whites. Additionally, African Americans who are living in poverty are three times as likely as those who are not living in poverty to experience psychological distress, and thus be at an increased risk of stress and possibly cognitive impairment.

  • Living in a Disadvantaged Neighborhood

One study identified neighborhoods as "disadvantaged" by taking into account poverty levels, employment rates, housing, and education levels. The researchers found that participants who lived in disadvantaged neighborhoods had lower scores on tests that measured immediate memory, cognitive speed and flexibility, working memory, and verbal learning, The researchers also found higher levels of an Alzheimer's marker in the spinal fluid of those who were from these lower socioeconomic neighborhoods. While the research didn't actually test for occurrence of Alzheimer's in different neighborhoods, lower cognitive scores and the presence of Alzheimer's biomarkers have been correlated with a higher risk of dementia.

African American Caregivers and Dementia

As is the case for other ethnic minorities such as Latinos, many African Americans with dementia are cared for by family caregivers. It is often expected that African American family members care for loved ones who are older and become ill. While this role may be viewed more as a normal expectation and not a burden, it still has significant consequences for the person and their caregiver.

African Americans may be less likely to ask for help, seek a diagnosis, or connect with community resources. Part of the reason for this may be related to a lack of connection or established trust in healthcare providers and/or community support organizations. Additionally, many people may lack access to healthcare services, in which case a diagnosis would not occur until later in the disease process.

Recommendations

Several organizations have called for an intentional approach to better serve African Americans who are living with dementia, as well as their family members. They suggest several strategies, including the following:

  • Provide culturally relevant communication about Alzheimer's disease. Distribute existing resources as well as develop new, culturally competent materials that target the specific risks related to African Americans, the early warning signs of dementia and prevention strategies for maintaining brain health.
  • Offer personal, in-home communication about resources. Reach out to families at their homes to offer caregiver support and training, learn what individuals and families would find helpful and provide education about accessing services.
  • Build community and church relationships. Many African Americans have a strong connection to their faith and communities. Network with local African American organizations and churches to build relationships and communication channels. These relationships will likely increase utilization of available resources as awareness and respect for these services increase.
  • Work to prevent caregiver burnout by offering services. Because African Americans may be less likely to utilize support and facility care, the risk of caregiver burnout is significant. Offer education about respite care and adult day care programs in order to help keep a loved one at home and reduce the chance of caregiver overload.

A Word From Verywell

The disproportionate prevalence of dementia in the African American communities is noteworthy and, as healthcare professionals, friends and neighbors, it necessitates action. It can be overwhelming as we begin to understand this issue, but developing awareness and sharing that knowledge with others is a powerful and fairly simple first step we can take in response.

Sources:

Alzheimer's Association. African Americans and Alzheimer's. http://www.alz.org/africanamerican/

Alzheimer's Association International Conference. 2017. Four studies highlight racial disparities in dementia risk and incidence. https://www.alz.org/aaic/releases_2017/AAIC17-Sun-briefing-racial-disparities.asp

American Heart Association. African-Americans and Heart Disease, Stroke. July 2015. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/African-Americans-and-Heart-Disease_UCM_444863_Article.jsp#.WaGRJSiGPIU

Barnes LL, Bennett DA. Alzheimer’s Disease In African Americans: Risk Factors And Challenges For The Future. Health affairs (Project Hope). 2014;33(4):580-586. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/

Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer’s & dementia : the journal of the Alzheimer’s Association. 2016;12(3):216-224. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969071/

Mental Health America. Black & African American Communities and Mental Health. http://www.mentalhealthamerica.net/african-american-mental-health

U.S. Bureau of the Census, “Income and Poverty in the United States: 2016. https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-256.pdf

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