Disparities in Alzheimer Disease and Mild Cognitive Impairment Among Native Hawaiians and Pacific Islanders

Abstract

Background: Previous studies of racial differences in Alzheimer disease (AD) presentation have not included Native Hawaiians and Pacific Islanders (NHPI). Objective: To explore the presentation of AD and mild cognitive impairment (MCI) in NHPI. Method: We conducted a retrospective review of patient records from Hawaii with a diagnosis of unspecified AD or MCI from September 2000 to September 2019. Variables of interest included age at diagnosis, gender, race, marital status, insurance, comorbidities, and scores on the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). Results: We reviewed the medical records of 598 patients, including 224 Asians, 202 Whites, 87 NHPI, and 85 Other. AD was more dominant than MCI across all of the groups, with the highest percentage in NHPI. Among the mean ages of diagnosis, NHPI were the youngest. Across all groups, a higher proportion of women than men had AD, with the highest female prevalence among NHPI. Hypertension, hyperlipidemia, and type II diabetes were highest among NHPI compared with the other groups. Of individuals with MMSE/MoCA scores, there were significant variations in scores by racial group. The mean MMSE/MoCA score was highest among Whites and lowest among NHPI. Conclusion: Compared with other racial groups, NHPI have a higher proportion of AD than MCI at diagnosis, are diagnosed at a younger age, have a higher female prevalence, have more comorbidities that may contribute to AD/MCI onset, and present with lower MMSE scores.

Volume, scope, and consideration of ethical issues in Indigenous cognitive impairment and dementia research: A systematic scoping review of studies published between 2000-2021

“…Fifteen studies examined the prevalence and/or incidence of dementia or cognitive impairment in Indigenous populations (Carty et al, 2020; Cotter et al, 2012; Cullum et al, 2018; Jacklin et al, 2013; Jervis et al, 2007; Kirkpatrick et al, 2019; Li et al, 2014; Lo Giudice et al, 2016; Mayeda et al, 2016; Panegyres et al, 2021; Pu’un et al, 2014; Radford, Mack, Draper, Chalkley, Daylight, et al, 2015; S. G. Russell et al, 2021; Smith et al, 2008; White et al, 2019), while nine studies examined risk factors for, and correlates of, dementia (Derrig et al, 2020; Hocking et al, 2019; Petrasek MacDonald et al, 2015; Radford et al, 2019; Smith et al, 2010, 2021; Verney et al, 2008; Weiner et al, 2003, 2008). Fifteen studies focused on dementia diagnosis, including 10 studies that explored the development, validation and/or psychometric properties of dementia screening tests for specific populations (Dingwall et al, 2017; Jacklin, Pitawanakwat, Blind, O'Connell, et al, 2020; Lo Giudice et al, 2011; LoGiudice et al, 2006; Radford, Mack, Draper, Chalkley, Delbaere, et al, 2015; Smith et al, 2016; Smith et al, 2009; Smith et al, 2007; Walker et al, 2021; Whyte et al, 2005), four studies that examined implementation of different methods for assessing dementia (S. Russell et al, 2021; Russell et al, 2016; Wadsworth et al, 2016; Weiner et al, 2011), and one study that generated normative data (Lavrencic et al, 2019).…”

“…Studies were mostly conducted in Australia with Aboriginal and/or Torres Strait Islander people (n = 30, see Figure 3) (Arkles et al, 2020; Bryant et al, 2021; Cotter et al, 2012; Cox et al, 2019; Derrig et al, 2020; Dingwall et al, 2017; Garvey et al, 2011; Hocking et al, 2019; Lavrencic et al, 2019; Li et al, 2014; Lindeman et al, 2012; Lo Giudice et al, 2016; Lo Giudice et al, 2011; LoGiudice et al, 2006; Panegyres et al, 2021; Radford et al, 2019; Radford, Mack, Draper, Chalkley, Daylight, et al, 2015; Radford, Mack, Draper, Chalkley, Delbaere, et al, 2015; S. Russell et al, 2021; Russell et al, 2016; S. G. Russell et al, 2021; Smith et al, 2016; Smith et al, 2010; Smith et al, 2009; Smith et al, 2008; Smith et al, 2011; Smith et al, 2007; Taylor et al, 2012; Waller et al, 2021; White et al, 2019). Twenty-three studies were conducted in the United States of America with Native American Indian, Alaskan and Hawaiian people (Browne et al, 2021; Carty et al, 2020; Fife et al, 2020; Jernigan et al, 2020; Jervis et al, 2007; Jervis & Manson, 2007; Kirkpatrick et al, 2019; Korn et al, 2009; Lewis et al, 2020; Martindale-Adams et al, 2017; Mayeda et al, 2016, 2017; Mehta et al, 2008; Sentell et al, 2015; Smith et al, 2021; Verney et al, 2008; Wadsworth et al, 2016;…”

“…An additional 10 studies identified employment of Indigenous staff or community members for data collection, field work or trial coordination (Garvey et al, 2011; Jacklin, Pitawanakwat, Blind, Lemieux, et al, 2020; Jervis & Manson, 2007; Korn et al, 2009; Lo Giudice et al, 2016; Smith et al, 2007; Smith et al, 2008; Smith et al, 2009; Smith et al, 2010; Verney et al, 2008) and one study reported using a cultural advisor (White et al, 2019). No information about Indigenous leadership or involvement were reported for 33 studies (Blix & Hamran, 2017; Carty et al, 2020; Chen et al, 2019; Cotter et al, 2012; Cullum et al, 2018; Cullum et al, 2020; Derrig et al, 2020; Fife et al, 2020; Hanssen, 2013; Jacklin et al, 2013; Jernigan et al, 2020; Jervis et al, 2007; Kirkpatrick et al, 2019; Lewis et al, 2020; Li et al, 2014; Mayeda et al, 2017; Mayeda et al, 2016; Mehta et al, 2008; Panegyres et al, 2021; Petrasek MacDonald et al, 2015; Pu’un et al, 2014; S. Russell et al, 2021; Russell et al, 2016; Sentell et al, 2015; Smith et al, 2021; Wadsworth et al, 2016; Waller et al, 2021; Weiner et al, 2007; Weiner et al, 2003; Weiner et al, 2008; Weiner et al, 2011; Whyte et al, 2005; Wiese et al, 2020).…”

“…Twenty studies did not directly recruit participants. In 17 studies, secondary analysis was conducted of datasets that had already been collected (Carty et al, 2020; Cotter et al, 2012; Cullum et al, 2018, 2020; Jacklin et al, 2013; Li et al, 2014; Mayeda et al, 2016, 2017; Mehta et al, 2008; Panegyres et al, 2021; Petrasek MacDonald et al, 2015; Sentell et al, 2015; Smith et al, 2021; Waller et al, 2021; Weiner et al, 2003, 2007; Whyte et al, 2005) and three studies were implementation studies/case studies that did not report on recruitment of participants (Martin & Paki, 2012; Martindale-Adams et al, 2017; Weiner et al, 2011). Of the remaining studies, many were comprised of heterogeneous samples of participants.…”

“…Most studies used cross-sectional (n = 34) (Carty et al, 2020; Cotter et al, 2012; Cullum et al, 2018; Garvey et al, 2011; Hocking et al, 2019; Jervis et al, 2007; Kirkpatrick et al, 2019; Lavrencic et al, 2019; Li et al, 2014; Lo Giudice et al, 2011; LoGiudice et al, 2006; Panegyres et al, 2021; Petrasek MacDonald et al, 2015; Pu’un et al, 2014; Radford et al, 2019; Radford, Mack, Draper, Chalkley, Daylight, et al, 2015; Radford, Mack, Draper, Chalkley, Delbaere, et al, 2015; S. Russell et al, 2021; Russell et al, 2016; S. G. Russell, Quigley, Thompson, et al, 2021; Sentell et al, 2015; Smith et al, 2016; Smith et al, 2010; Smith et al, 2009; Smith et al, 2008; Smith et al, 2021; Verney et al, 2008; Wadsworth et al, 2016; Walker et al, 2021; Waller et al, 2021; Weiner et al, 2008; Weiner et al, 2011; White et al, 2019; Whyte et al, 2005) or qualitative (n = 24) (Arkles et al, 2020; Blix & Hamran, 2017; Browne et al, 2021; Bryant et al, 2021; Chen et al, 2019; Dudley et al, 2019; Fife et al, 2020; Finkelstein et al, 2012; Forbes et al, 2013; Gilmour et al, 2016; Hanssen, 2013; Hulko et al, 2010; Jacklin et al, 2015; Jacklin, Pitawanakwat, Blind, Lemieux, et al, 2020; Jacklin, Pitawanakwat, Blind, O'Connell, et al, 2020;…”