Race, Culture, and Alzheimer’s Disease

As of 2014, 1.6% of the American population, 5 million people, were afflicted by Alzheimer’s Disease (AD) and other related dementias. This number is only expected to grow with a prediction that by 2060, AD and other dementias will affect 3.3% of Americans [1]. Like many biological ailments, the diagnosis of AD varies on racial lines. Of adults 65 and older with AD, 8.4% are Asian and Pacific Islanders, 9.1% are Native Americans, 10% are non-Hispanic whites, 12% are Hispanics, and 14% are African-Americans [1].

This ethnoracial disparity is the intersectional consequence of biology and the cultural values of these communities.

Biological predispositions to both the onset and progress of AD are inherited through genetics and in large part, vary across races. Studies report higher total brain volume in Hispanics and African-Americans when compared to non-Hispanic whites, but differ on whether cerebrovascular disease (CVD), a related biomarker of AD, has ethnoracial differences in terms of prevalence. Levels of another neuroimaging biomarker, beta-amyloid pathology, were higher in African-Americans, another factor that explains the relatively high diagnosis rate of AD in this population. Nevertheless, while African-Americans have a higher percentage of AD diagnoses, their rate of cognitive decline is slower, suggesting that genetics influences both the onset and progress of AD [2]. However, these data have been collected from studies with limited non-White participation indicating that more studies, and targeted ones at that, need to be conducted to better understand the connection between non-white populations and biomarkers of AD.

The onset of Alzheimer’s Disease involves a combination of biological predispositions and behavioral practices that differ across races and ethnicities [2]. Vascular risk factors for AD like high cholesterol and vascular inflammation are more common in ethnic minorities, a statistic that explains the higher percentage of AD diagnoses in Hispanic and African-American communities [3]. However, while the presence of the apoE4 allele is associated with a higher risk of AD in most racial groups, it is associated with a reduced risk in African-Americans. Lastly, behavioral practices like food habits (eg: a diet comprising more Asian than Western food, i.e., fish and curcumin as opposed to salt, fat and simple carbohydrates) have been linked to lower rates of cognitive decline, suggesting that genes and diet interact in ways that influence the severity of AD.

The extant information about AD in non-white populations has been limited by several social factors including how these communities perceive cognitive changes, access to adequate health care, ascension to enroll in clinical trials, and the importance placed on the role and treatment of elders in these communities [2]. Medical professionals working with diverse communities in the diagnosis of AD must be cognizant of the interactions between these biological and social considerations. Given the relative stigma of AD and other dementias, diagnoses must be made keeping in mind the racial and ethnic biological differences and recommendations must be made keeping in mind the cultural implications of diagnosis and caretaking.

For instance, in Hispanic cultures, dementia and AD are often viewed as “the evil eye”, as one losing their mind, or as a consequence of having experienced a tough life. In Chinese communities, early symptoms such as memory loss and confusion are ‘normal’ parts of growing old, while the later stages are seen as signs of mental illness [4]. However, in both cultures, familial members of the diagnosed will still be the primary caretakers. African American, Chinese American, and Irish American caregivers all viewed AD as a “loss of identity” or “loss of self” [5]. Hence, it is seen that in most minority cultures, a diagnosis of AD is taken negatively.

The very diagnosis of AD is a result of patient performance on a variety of tests that investigate cognitive function. However, the cultural validity of these tests, and by extension the diagnosis itself, has been criticized, as not all peoples undergo formal education as is understood, valued, and tested by Western society [2]. This warrants the need for a diagnosis tool that is more culturally universal. Esurgi Biotech’s Eye AD, a technology that can diagnose AD by tracking eye movements, stands as an alternative that is particularly useful in culturally diverse societies.

References

1. Center for Disease Control. (2018, September 20). U.S. burden of Alzheimer’s Disease, Related DEMENTIAS to double by 2060.
2. Babulal, G. M., Quiroz, Y. T., Albensi, B. C., Arenaza-Urquijo, E., Astell, A. J., Babiloni, C., Bahar-Fuchs, A., Bell, J., Bowman, G. L., Brickman, A. M., Chételat, G., Ciro, C., Cohen, A. D., Dilworth-Anderson, P., Dodge, H. H., Dreux, S., Edland, S., Esbensen, A., Evered, L., Ewers, M., … International Society to Advance Alzheimer’s Research and Treatment, Alzheimer’s Association (2019). Perspectives on ethnic and racial disparities in Alzheimer’s disease and related dementias: Update and areas of immediate need. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 15(2), 292–312.
3. Chui, H. C., & Gatz, M. (2005). Cultural Diversity in Alzheimer Disease. Alzheimer Disease & Associated Disorders, 19(4), 250–255.
4. Gray, H. L., Jimenez, D. E., Cucciare, M. A., Tong, H.-Q., & Gallagher-Thompson, D. (2009). Ethnic Differences in Beliefs Regarding Alzheimer Disease Among Dementia Family Caregivers. The American Journal of Geriatric Psychiatry, 17(11), 925–933.
5. Janevic, M. R., & M Connell, C. (2001). Racial, Ethnic, and Cultural Differences in the Dementia Caregiving Experience. The Gerontologist, 41(3), 334–347.