Background: Neuropsychiatric symptoms are highly prevalent in frontotemporal degeneration (FTD). Prior research suggests there are disparities in the clinical presentation of dementia when comparing Black and White individuals but this has not been investigated in the context of FTD specifically. The aim of the present study is to investigate racial disparities in dementia severity, functional impairment and neuropsychiatric symptoms in individuals with a clinical diagnosis of FTD. Methods: Using National Alzheimers Coordinating Center (NACC) data, we evaluated 63 Black and 2,356 White individuals living with a clinical diagnosis of FTD (behavioral variant FTD or primary progressive aphasia) and a healthy control group of 1899 Black and 9122 White individuals with normal behavior and cognition. We compared demographic characteristics, dementia severity, functional impairment and neuropsychiatric symptoms at initial NACC visit by examining differences on Clinical Dementia Rating Scale (CDR), Functional Assessment Scale (FAS) and Neuropsychiatric Inventory (NPI) using multivariable linear and logistic regression models, covarying for age at visit, disease duration, sex, and education. Models evaluating differences in neuropsychiatric symptoms additionally controlled for dementia severity. Results: Black individuals with FTD were considerably underrepresented, comprising only 2.5 percent of the clincial sample. In comparison to White individuals, Black individuals with FTD had a higher degree of dementia severity on CDR (CDR sum of boxes; p=0.03 CDR global, p=.006), greater functional impairment (FAS total; p=0.01) and more delusions (p=0.01), agitation (p=0.04) and depression (p=0.03) on the NPI. White individuals with FTD were more likely to demonstrate apathy (p=0.03). Within the normal control group, Black individuals reported less depression, anxiety, agitation, and nighttime behaviors (depression; p < 0.001; anxiety; p = 0.006; agitation; p = 0.048; nighttime behaviors; p < 0.001) compared to White normal controls. Discussion: The present study suggests there are significant disparities in dementia severity, functional impairment and neuropsychiatric presentations at initial visit between Black and White individuals with FTD. Future work must address racial disparities in FTD and their underlying social determinants as well as the lack of representation of non-White individuals in nationally representative neurodegenerative disease registries in order identify appropriate interventions
BackgroundRacial disparities in many aging‐related health outcomes are persistent and pervasive among older Americans. There are well‐documented inequities in the social determinants of health for older adults, including the social and physical environment, due to structural and environmental racism, but there is little understanding of the biological intermediates by which social determinants affect disparate health outcomes. Biological aging measured by DNA methylation (DNAm) is robustly associated with worse age‐related outcomes and higher social adversity. We hypothesize that individual social determinants, the social environment, and air pollution exposures interact to contribute to racial disparities in DNAm aging according to GrimAge and Dunedin Pace of Aging methylation (DPoAm).MethodWe performed retrospective cross‐sectional analyses among 3250 non‐Hispanic participants (80.3% white, 19.7% Black) in the Health and Retirement Study whose 2016 epigenetic age is linked to survey responses and geographic data. DNAm aging is defined as the residual after regressing epigenetic age on chronological age. Measures of the neighborhood social environment include the Social Deprivation Index and perceived social stress. Air pollution exposures include particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone. Individual‐level determinants include socioeconomic status, healthcare access, health status, and health behaviors. We implemented multivariable linear regression models to identify significant associations, interactions, and mediators in the relationship between each DNAm aging measure and the social and environmental determinants.ResultWe found on average Black individuals have significantly accelerated DNAm aging compared to white individuals (599% and 498%) according to GrimAge and DPoAm, respectively. Individual‐level factors evaluated account for approximately 43% of the disparity in GrimAge and 34% in DPoAm. Further results suggest that associations between neighborhood social environment and DNAm aging are significant and mediated by individual‐level factors. PM2.5 may be associated with DPoAm acceleration in certain sub‐populations. NO2 and ozone are not significantly associated with DNAm aging. We are investigating individual‐level factors that mediate social environmental exposures and increase vulnerability to PM2.5.ConclusionDNAm aging may play a role in social determinants “getting under the skin” and contributing to age‐related health disparities between Black and white Americans. Work is ongoing to determine the environmental and individual factors that contribute to these disparities.
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