Health Disparities in Dementia

Balls-Berry, Joyce E.; Babulal, Ganesh M.

doi:10.1212/con.0000000000001088

Cited by 21 publications

(31 citation statements)

References 59 publications

(110 reference statements)

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“…For more information on health disparities and social determinants of health, refer to the article "Health Disparities in Dementia" by Joyce (Joy) E. Balls-Berry, PhD, MPE, and Ganesh M. Babulal, PhD, OTD, MSCI, MOT, in this issue of Continuum. 21 APOE ε4 predisposes to the accumulation of amyloid-β in cerebral blood vessels (resulting in CAA) as well as in the brain parenchyma (amyloid plaques) and is another risk factor for vascular brain injury, but it is not a risk factor for coronary artery disease. Thus, when enumerating cerebrovascular risk factors, one must think beyond traditional cardiovascular risk factors.…”

Section: Vascular Risk Factorsmentioning

confidence: 99%

Vascular Cognitive Impairment and Dementia

Wong¹,

Chui²

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article gives a broad overview of vascular cognitive impairment and dementia, including epidemiology, pathophysiology, clinical approach, and management. Emphasis is placed on understanding the common underlying types of cerebrovascular disease (including atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy) and awareness of rare inherited cerebrovascular disorders.RECENT FINDINGS: The pathophysiology of vascular cognitive impairment and dementia is heterogeneous, and the most recent diagnostic criteria for vascular cognitive impairment and dementia break down the diagnosis of major vascular dementia into four phenotypic categories, including subcortical ischemic vascular dementia, poststroke dementia, multi-infarct dementia, and mixed dementia. Control of cardiovascular risk factors, including management of midlife blood pressure, cholesterol, and blood sugars, remains the mainstay of prevention for vascular cognitive impairment and dementia. Cerebral amyloid angiopathy requires special consideration when it comes to risk factor management given the increased risk of spontaneous intracerebral hemorrhage. Recent trials suggest some improvement in global cognitive function in patients with vascular cognitive impairment and dementia with targeted cognitive rehabilitation. SUMMARY: Thorough clinical evaluation and neuroimaging form the basis for diagnosis. As vascular cognitive impairment and dementia is the leading nondegenerative cause of dementia, identifying risk factors and optimizing their management is paramount. Once vascular brain injury has occurred, symptomatic management should be offered and secondary prevention pursued.

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Section: Vascular Risk Factorsmentioning

confidence: 99%

Vascular Cognitive Impairment and Dementia

Wong¹,

Chui²

2022

CONTINUUM: Lifelong Learning in Neurology

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“…The causes of racial disparities in FTD prevalence and symptoms are likely complex and may be interrelated to the causes of racial disparities in healthcare utilization. There are likely multiple systemic and structural barriers that limit equitable access to health information (such as on the signs and symptoms of atypical dementias) and the specialized healthcare 28,29 needed for timely diagnosis and management of FTD. Even when health information and healthcare resources are accessible, lack of trust in health systems 30 that has been perpetuated by a history of institutional racism 31 and higher costs associated with the dementia care received by Black individuals may deter healthcare seeking behavior.…”

Section: Discussionmentioning

confidence: 99%

Differences in Neuropsychiatric Features in Black and White Individuals Diagnosed with Frontotemporal Degeneration

Jin

McMillan

Yannatos

et al. 2023

Preprint

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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

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“…However, as race increasingly is recognized as a social rather than biological construct, the understanding that social determinants of health likely play an important role in health disparities is growing. For more information on social determinants of health and heath disparities, refer to the article “Health Disparities in Dementia” by Joyce (Joy) E. Balls-Berry, PhD, MPE, and Ganesh M. Babulal, PhD, OTD, MSCI, MOT 10 , in this issue of Continuum .…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Alzheimer Disease

McDade¹

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWAlzheimer disease (AD) is the most common cause of dementia in adults (mid to late life), highlighting the importance of understanding the risk factors, clinical manifestations, and recent developments in diagnostic testing and therapeutics.RECENT FINDINGSAdvances in fluid (CSF and blood-based) and imaging biomarkers are allowing for a more precise and earlier diagnosis of AD (relative to non-AD dementias) across the disease spectrum and in patients with atypical clinical features. Specifically, tau- and amyloid-related AD pathologic changes can now be measured by CSF, plasma, and positron emission tomography (PET) with good precision. Additionally, a better understanding of risk factors for AD has highlighted the need for clinicians to address comorbidities to maximize prevention of cognitive decline in those at risk or to slow decline in patients who are symptomatic. Recent clinical trials of amyloid-lowering drugs have provided not only some optimism that amyloid reduction or prevention may be beneficial but also a recognition that addressing additional targets will be necessary for significant disease modification.SUMMARYRecent developments in fluid and imaging biomarkers have led to the improved understanding of AD as a chronic condition with a protracted presymptomatic phase followed by the clinical stage traditionally recognized by neurologists. As clinical trials of potential disease-modifying therapies continue, important developments in the understanding of the disease will improve clinical care now and lead to more effective therapies in the near future.

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Health Disparities in Dementia

Cited by 21 publications

References 59 publications

Vascular Cognitive Impairment and Dementia

Vascular Cognitive Impairment and Dementia

Differences in Neuropsychiatric Features in Black and White Individuals Diagnosed with Frontotemporal Degeneration

Alzheimer Disease

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