It’s known that certain racial and ethnic groups such as African Americans and Hispanics are at higher risk for Alzheimer’s disease. Now, a unique BrightFocus-funded study has confirmed that African Americans and Hispanics with certain psychiatric symptoms such as anxiety, apathy/indifference, and irritability have a higher risk of developing cognitive impairment, often a precursor to Alzheimer’s disease and other dementias.
The study, led by BrightFocus Alzheimer’s Disease Research grantee Ganesh Babulal, MSCI, OTD, PhD, and published in the journal Alzheimer’s and Dementia, included nearly 7,000 participants of various races and ethnicities.
It looked at 12 neuropsychiatric symptoms, also called behavioral or psychological symptoms, that are risk factors for cognitive impairment: delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, euphoria/elation, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, night-time behavior, and appetite/eating.
The researchers found that compared to non-Hispanic white Americans, African Americans with these symptoms are more likely to progress to cognitive impairment, followed by Hispanic and then Asian participants.
By recognizing and addressing this disparity through screenings, the researchers said, steps can be taken to close the gap.
About the research findings
Using a data repository from the National Alzheimer’s Coordinating Center, Dr. Babulal’s team searched for studies investigating the risk associated with neuropsychiatric symptoms and progression to cognitive impairment, and whether race made a difference.
The participants, who were not cognitively impaired at the start of the study, were followed for over 14 years.
African Americans had an increased risk of progressing to cognitive impairment in all 12 symptom models, Hispanics in six, and Asian Americans in two. Having neuropsychiatric symptoms increases Alzheimer’s risk for all people, the researchers said, but the risk was higher across those ethnic and racial groups.
What the research tells us
The researchers speculated that African Americans and Hispanics may not recognize symptoms or seek treatment as early as their white counterparts, which delays a potential diagnosis and potential treatment.
They pointed out that the responsibility to seek health care does not lie solely with an individual or their family. Rather, it is a complex interaction between factors such as culture, health care access, affordability, trust in medical institutions, stigma, and awareness, among others.
Social and environmental factors such as education, socioeconomic status, racism, discrimination, outdoor and indoor pollution, and living conditions, they said, also increase the risk for both neuropsychiatric symptoms and cognitive impairment.
Further, African Americans have twice the risk of dementia compared to non-Hispanic white Americans, and Hispanic Americans have one and a half times the risk.
Looking to the future
By 2050, the number of Americans living with dementia is expected to nearly double to 12.7 million, with costs rising to $1.5 trillion. Dementia takes a significant toll on individuals, families, and society at large.
Increased awareness and screening for cognitive decline in minority groups may help with earlier diagnosis. In addition, representation in clinical trials needs to be greatly increased so that we can better understand and treat every population.
The researchers noted that with the increasing diversity among racial and ethnic groups, the U.S. will also see a population increase in African Americans, Hispanics, and Asian over the next three decades, while white population growth is expected to decrease.
Earlier diagnosis of neuropsychiatric symptoms and cognitive impairment can lead to earlier treatment that may slow the progression toward dementia. Leqembi, an anti-amyloid drug that’s received full FDA approval, and other drugs in the treatment pipeline have been shown to reduce cognitive decline at a historic rate in the early stages of Alzheimer’s, providing hope for the millions at risk for cognitive decline and dementia.
