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Zhu Y, Park S, Kolady R, Zha W, Ma Y, Dias A, McGuire K, Hardi A, Lin S, Ismail Z, Adkins‐Jackson PB, Trani J, Babulal GM. A systematic review/meta-analysis of prevalence and incidence rates illustrates systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research. Alzheimers Dement 2024; 20:4315-4330. [PMID: 38708587 PMCID: PMC11180860 DOI: 10.1002/alz.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 05/07/2024]
Abstract
We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian-American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random-effects meta-analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian-American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non-Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01-33.8) per 1000 person-years with a range of 75.19-13.59 (12.89-14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. HIGHLIGHTS: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian-Americans. There is limited data on group-specific risk factors for ADRD among Asian-Americans. The average prevalence of (ADRD) among Asian-Americans was found to be 7.4%, with a wide range from 0.5% to 46%.
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Affiliation(s)
- Yiqi Zhu
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | - Soobin Park
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Wenqing Zha
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Ying Ma
- University of Houston56B M.D. Anderson Library HoustonTexasUSA
| | - Amanda Dias
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | | | - Angela Hardi
- Bernard Becker Medical LibraryWashington University School of MedicineSt. LouisMissouriUSA
| | - Sunny Lin
- Division of General Medical SciencesDepartment of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health SciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterDevonUK
| | - Paris B. Adkins‐Jackson
- Departments of Epidemiology and Sociomedical SciencesMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Jean‐Francois Trani
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgCnr Kingsway & University RoadsJohannesburgSouth Africa
- National Conservatory of Arts and CraftsParisFrance
| | - Ganesh M. Babulal
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- National Conservatory of Arts and CraftsParisFrance
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Voigt RM, Ouyang B, Keshavarzian A. Outdoor Nighttime Light Exposure (Light Pollution) is Associated with Alzheimer's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.14.24302831. [PMID: 38405987 PMCID: PMC10889016 DOI: 10.1101/2024.02.14.24302831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Alzheimer's disease (AD) prevalence has increased in the last century which can be attributed to increased lifespan, but environment is also important. This study evaluated the relationship between outdoor nighttime light exposure and AD prevalence in the United States. Higher outdoor nighttime light was associated with higher prevalence of AD. While atrial fibrillation, diabetes, hyperlipidemia, hypertension, and stroke were associated more strongly with AD prevalence than nighttime light intensity, nighttime light was more strongly associated with AD prevalence than alcohol abuse, chronic kidney disease, depression, heart failure, and obesity. Startlingly, nighttime light exposure more strongly associated with AD prevalence in those under the age of 65 than any other disease factor examined. These data indicate a need to investigate how nighttime light exposure influences AD pathogenesis.
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Affiliation(s)
- Robin M Voigt
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center; Chicago, IL, USA
- Department of Internal Medicine, Rush University Medical Center; Chicago, IL, USA
- Department of Anatomy & Cell Biology, Rush University Medical Center; Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ali Keshavarzian
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center; Chicago, IL, USA
- Department of Internal Medicine, Rush University Medical Center; Chicago, IL, USA
- Department of Anatomy & Cell Biology, Rush University Medical Center; Chicago, IL, USA
- Department of Physiology, Rush University Medical Center, Chicago, IL, USA
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Kota KJ, Dawson A, Papas J, Sotelo V, Su G, Li M, Lee W, Estervil J, Marquez M, Sarkar S, Lopez LL, Hu WT. Factors associated with attitudes toward research MRI in older Asian Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12449. [PMID: 38356478 PMCID: PMC10865479 DOI: 10.1002/trc2.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION South Asian (SA) and East Asian (EA) older adults represent the fastest-growing racial/ethnic groups of Americans at risk for dementia. While recruiting older SA adults into a brain health study, we encountered unexpected hesitancy toward structural brain magnetic resonance imaging (MRI) analysis and stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as personal MRI experience, perceived MRI safety, and concerns for personal risk for future dementia/stroke. METHODS We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing impact on health, and attitudes related to dementia (including LoC) and research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey (offered in English, Chinese, Korean, and Spanish) and modeled the proportional odds (PO) for favorable attitudes toward research activities. RESULTS Seventy-seven SA and 84 EA respondents were analyzed alongside 95 White, Black, or Hispanic adults. White (PO = 2.54, p = 0.013) and EA (PO = 2.14, p = 0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p = 0.006) but still shared SA respondents' lower wish (measured by proportion of total) to learn of incidental MRI findings. DISCUSSION SA-and EA compared to SA-older adults had low desire to learn of incidental MRI findings but had different attitudes toward future dementia/stroke risks. A culturally appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research. Highlights Older Asian Americans have limited interest in incidental findings on research MRISouth Asians are most likely to attribute dementia to people's own behaviorsSouth Asians' attitudes mediate lower support for healthy volunteers in researchSouth and East Asians differ in dementia worries and research-related attitudes.
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Affiliation(s)
- Karthik J Kota
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Departments of MedicineRutgers‐Robert Wood Johnson Medical SchoolInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Alice Dawson
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Julia Papas
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Victor Sotelo
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Guibin Su
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Mei‐Ling Li
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Woowon Lee
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Jaunis Estervil
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Melissa Marquez
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Shromona Sarkar
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Lisa Lanza Lopez
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - William T. Hu
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
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Ramos MD, Heath J, Lee D, Wright LS. Designing dementia care activation program for Filipino American caregivers. Public Health Nurs 2023; 40:621-628. [PMID: 37415444 DOI: 10.1111/phn.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/30/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE This research study aims to identify the fundamental components of community adaptation for a culturally tailored care partner activation program for Filipino American family caregivers of patients with Alzheimer's Disease and related dementia (ADRD). DESIGN The study utilized focus group interviews with community nurse leaders, stakeholders, and family caregivers of patients with ADRD. RESULTS The research revealed that education and knowledge about the disease, community-based services and facilities, support groups and resources, spiritual and cultural values, and access to transportation are all critical components for community adaptation. CONCLUSION The findings suggest that a culturally tailored care partner activation program that incorporates these components can enhance the quality of life for Filipino American caregivers and their loved ones with ADRD. The nursing implications of the study underscore the importance of nurses being culturally competent and sensitive to the unique challenges faced by Filipino American caregivers. Nurses can provide valuable support to caregivers by educating them, connecting them with community resources, and advocating for culturally responsive care practices.
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Affiliation(s)
- Mary Dioise Ramos
- Wellstar School of Nursing, Kennesaw State University, Kennesaw, Georgia
| | - Jarrett Heath
- Graduate Research Assistant, Wellstar School of Nursing, Kennesaw, Georgia
| | - Danielle Lee
- Graduate Research Assistant, Wellstar School of Nursing, Kennesaw, Georgia
| | - LaNita S Wright
- Department of Health Promotion and Physical Education, Kennesaw, Georgia
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de Leon J, Bondoc I, Mamuyac E, Posecion L, Europa E, Kintanar LC, Roco N, Lamoca M, Escueta DP, Park VMT. The development of the Cognitive Assessment for Tagalog Speakers (CATS): A culturally and linguistically tailored test battery for Filipino Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12418. [PMID: 37662963 PMCID: PMC10474327 DOI: 10.1002/trc2.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Filipino Americans are one of the largest Asian American and Pacific Islander (AAPI) populations in the United States (US). Previous studies suggest that Filipino Americans have one of the highest incidence rates of Alzheimer's disease and related dementias (ADRD) among AAPI subgroups. Despite the expected increase in Filipino Americans with ADRD, no studies to-date have validated neuropsychological measures in the United States for speakers of Tagalog, a major language spoken by Filipino Americans. A significant barrier to dementia care and diagnosis is the lack of linguistically and socioculturally appropriate cognitive tasks for Tagalog speakers. To address this need, we developed and piloted the Cognitive Assessment for Tagalog Speakers (CATS), the first neuropsychological battery for the detection of ADRD in Filipino American Tagalog speakers. METHODS Based on evidence-based neuropsychological batteries, we adapted and constructed de novo tasks to measure performance across 4 main cognitive domains: visual/verbal memory, visuospatial functioning, speech and language, and frontal/executive functioning. Tasks were developed with a team of bilingual English/Tagalog, bicultural Filipino American/Canadian experts, including a neurologist, speech-language pathologist, linguist, and neuropsychologist. We recruited Tagalog-speaking participants of age 50+ through social media advertisements and recruitment registries for this cross-sectional study. We present the CATS design and protocol. RESULTS To-date, the CATS battery has been administered to 26 healthy control participants (age 64.5 ± 7.8 years, 18F/8 M) at an academic institution in Northern California, United States. The development and administration of the CATS battery demonstrated its feasibility but also highlighted the need to consider the effects of bilingualism, language typology, and cultural factors in result interpretation. DISCUSSION The CATS battery provides a mechanism for cognitive assessment of Filipino Americans, a population that has been underrepresented in ADRD research. As we move toward the treatment and cure of ADRD, linguistically and socioculturally appropriate cognitive tests become even more important for equitable care.
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Affiliation(s)
- Jessica de Leon
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ivan Bondoc
- Department of LinguisticsUniversity of TorontoTorontoOntarioCanada
| | - Eugenie Mamuyac
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lainie Posecion
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Eduardo Europa
- Department of Communicative Disorders and SciencesSan Jose State UniversitySan JoseCaliforniaUSA
| | | | - Niecholle Roco
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mikkael Lamoca
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Danielle P. Escueta
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Van M. Ta Park
- Department of Community Health SystemsSchool of NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Asian American Research Center on Health (ARCH)University of California San FranciscoSan FranciscoCaliforniaUSA
- Multiethnic Health Equity Research Center (MERC)University of California San FranciscoSan FranciscoCaliforniaUSA
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Kota K, Dawson A, Papas J, Sotelo V, Su G, Li ML, Lee W, Estervil J, Marquez M, Sarkar S, Lopez LL, Hu WT. Too much information? Asian Americans' preferences for incidental brain MRI findings. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.17.23288629. [PMID: 37162874 PMCID: PMC10168418 DOI: 10.1101/2023.04.17.23288629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION South Asian (SA) and East Asian (EA) older adults represent the fastest growing group of Americans at risk for dementia, but their participation in aging and dementia research has been limited. While recruiting healthy SA older adults into a brain health study, we encountered unexpected hesitancy towards structural brain MRI analysis along with some stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as one's own MRI experience, perceived MRI safety, and concerns for one's own risks for future dementia/stroke. METHODS We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing health implications, and attitudes related to dementia as well as research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey, and modeled the proportional odds (P.O.) for pro-research attitudes. RESULTS 77 SA and 84 EA respondents were analyzed with 95 non-Asian adults. White (P.O.=2.54, p=0.013) and EA (P.O.=2.14, p=0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p=0.006), but still shared SA respondents' low desire to learn of incidental MRI findings. DISCUSSION SA and EA older adults had different attitudes towards future dementia/stroke risks, but shared a low desire to learn of incidental MRI findings. A culturally-appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research.
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Affiliation(s)
- Karthik Kota
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Alice Dawson
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Julia Papas
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Victor Sotelo
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Guibin Su
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Mei-Ling Li
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Woowon Lee
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Jaunis Estervil
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Melissa Marquez
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Shromona Sarkar
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Lisa Lanza Lopez
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - William T. Hu
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
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Woldemariam SR, Tang AS, Oskotsky TT, Yaffe K, Sirota M. Similarities and differences in Alzheimer's dementia comorbidities in racialized populations identified from electronic medical records. COMMUNICATIONS MEDICINE 2023; 3:50. [PMID: 37031271 PMCID: PMC10082816 DOI: 10.1038/s43856-023-00280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/24/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Alzheimer's dementia (AD) is a neurodegenerative disease that is disproportionately prevalent in racially marginalized individuals. However, due to research underrepresentation, the spectrum of AD-associated comorbidities that increase AD risk or suggest AD treatment disparities in these individuals is not completely understood. We leveraged electronic medical records (EMR) to explore AD-associated comorbidities and disease networks in racialized individuals identified as Asian, Non-Latine Black, Latine, or Non-Latine White. METHODS We performed low-dimensional embedding, differential analysis, and disease network-based analyses of 5664 patients with AD and 11,328 demographically matched controls across two EMR systems and five medical centers, with equal representation of Asian-, Non-Latine Black-, Latine-, and Non-Latine White-identified individuals. For low-dimensional embedding and disease network comparisons, Mann-Whitney U tests or Kruskal-Wallis tests followed by Dunn's tests were used to compare categories. Fisher's exact or chi-squared tests were used for differential analysis. Spearman's rank correlation coefficients were used to compare results between the two EMR systems. RESULTS Here we show that primarily established AD-associated comorbidities, such as essential hypertension and major depressive disorder, are generally similar across racialized populations. However, a few comorbidities, including respiratory diseases, may be significantly associated with AD in Black- and Latine- identified individuals. CONCLUSIONS Our study revealed similarities and differences in AD-associated comorbidities and disease networks between racialized populations. Our approach could be a starting point for hypothesis-driven studies that can further explore the relationship between these comorbidities and AD in racialized populations, potentially identifying interventions that can reduce AD health disparities.
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Affiliation(s)
- Sarah R Woldemariam
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
| | - Alice S Tang
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tomiko T Oskotsky
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA.
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
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Meyer OL, Park VT, Kanaya AM, Farias ST, Hinton L, Tiet QQ, Vuong Q, Nguyen S, Harvey D, Whitmer RA. Inclusion of Vietnamese Americans: Opportunities to understand dementia disparities. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12392. [PMID: 37251911 PMCID: PMC10209515 DOI: 10.1002/trc2.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
There is a dearth of research on cognitive aging and dementia in Asian Americans, particularly Vietnamese Americans, who are the fourth largest Asian subgroup in the United States. The National Institutes of Health is mandated to make certain that racially and ethnically diverse populations are included in clinical research. Despite the widespread recognition to ensure that research findings can be generalizable to all groups, there are no estimates of the prevalence or incidence of mild cognitive impairment and Alzheimer's disease and related dementias (ADRD) in Vietnamese Americans, nor do we understand ADRD risk and protective factors in this group. In this article, we posit that studying Vietnamese Americans contributes to a better understanding of ADRD in general and offers unique opportunities for elucidating life course and sociocultural factors that contribute to cognitive aging disparities. That is, the unique context of Vietnamese Americans may provide understanding in terms of within-group heterogeneity and key factors in ADRD and cognitive aging. Here, we provide a brief history of Vietnamese American immigration and describe the large but often ignored heterogeneity of Asian Americans in the United States, elucidate how early life adversity and stress might influence late-life cognitive aging, and provide a basis for the role of sociocultural and health factors in the study of Vietnamese cognitive aging disparities. Research with older Vietnamese Americans provides a unique and timely opportunity to more fully delineate the factors that contribute to ADRD disparities for all populations.
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Affiliation(s)
- Oanh L. Meyer
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Van Ta Park
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Alka M. Kanaya
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | - Ladson Hinton
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Quyen Q. Tiet
- California School of Professional Psychology at Alliant International UniversityEmeryvilleCaliforniaUSA
- National Center for PTSDDissemination and Training DivisionVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Quyen Vuong
- International Children Assistance Network (ICAN)San JoseCaliforniaUSA
| | | | - Danielle Harvey
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Rachel A. Whitmer
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
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Besser LM, Meyer OL, Jones MR, Tran D, Booker M, Mitsova D, Peterson R, Galvin JE, Bateman JR, Hayden KM, Hughes TM. Neighborhood segregation and cognitive change: Multi-Ethnic Study of Atherosclerosis. Alzheimers Dement 2023; 19:1143-1151. [PMID: 35869977 PMCID: PMC9868187 DOI: 10.1002/alz.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/28/2022] [Accepted: 04/29/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION We investigated associations between neighborhood racial/ethnic segregation and cognitive change. METHODS We used data (n = 1712) from the Multi-Ethnic Study of Atherosclerosis. Racial/ethnic segregation was assessed using Getis-Ord (Gi*) z-scores based on American Community Survey Census tract data (higher Gi* = greater spatial clustering of participant's race/ethnicity). Global cognition and processing speed were assessed twice, 6 years apart. Adjusted multilevel linear regression tested associations between Gi* z-scores and cognition. Effect modification by race/ethnicity, income, education, neighborhood socioeconomic status, and neighborhood social support was tested. RESULTS Participants were on average 67 years old; 43% were White, 11% Chinese, 29% African American/Black, 17% Hispanic; 40% had high neighborhood segregation (Gi* > 1.96). African American/Black participants with greater neighborhood segregation had greater processing speed decline in stratified analyses, but no interactions were significant. DISCUSSION Segregation was associated with greater processing speed declines among African American/Black participants. Additional follow-ups and comprehensive cognitive batteries may further elucidate these findings. HIGHLIGHTS A study of neighborhood racial/ethnic segregation and change in cognition. Study was based on a racially and geographically diverse, population-based cohort of older adults. Racial/ethnic segregation (clustering) was measured by the Getis-ord (Gi*) statistic. We saw faster processing speed decline among Black individuals in segregated neighborhoods.
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Affiliation(s)
- Lilah M. Besser
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine; Boca Raton, FL
| | - Oanh L. Meyer
- Department of Neurology, University of California, Davis, School of Medicine, Sacramento, CA 95817, US
| | - Miranda R. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, US
| | - Duyen Tran
- Departments of Neurology and Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, US
| | - Michaela Booker
- School of Medicine, University of California, Davis, Sacramento, CA 95817, US
| | - Diana Mitsova
- Department of Urban and Regional Planning and Institute for Human Health and Disease Intervention, Florida Atlantic University, Boca Raton, FL 33431, US
| | - Rachel Peterson
- Department of Public Health Sciences, University of California, Davis, Sacramento, CA 95616, US
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Boca Raton, FL, US
| | - James R. Bateman
- Departments of Neurology and Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, US
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, US
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, US
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Hayes-Larson E, Ikesu R, Fong J, Mobley TM, Gee GC, Brookmeyer R, Whitmer RA, Gilsanz P, Mayeda ER. Association of Education With Dementia Incidence Stratified by Ethnicity and Nativity in a Cohort of Older Asian American Individuals. JAMA Netw Open 2023; 6:e231661. [PMID: 36877520 PMCID: PMC9989900 DOI: 10.1001/jamanetworkopen.2023.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
IMPORTANCE High education protects against dementia, but returns on educational attainment may be different across sociodemographic groups owing to various social factors. Asian American individuals are a growing and diverse group, but little research has assessed dementia determinants in this population. OBJECTIVE To examine the association of education with dementia in a large cohort of Asian American individuals, stratifying by ethnicity and nativity. DESIGN, SETTING, AND PARTICIPANTS This cohort study used electronic health record (EHR) and survey data from the Research Program on Genes, Environment, and Health and the California Men's Health Study surveys (2002-2020). Data are from Kaiser Permanente Northern California, an integrated health care delivery system. This study used a volunteer sample who completed the surveys. Participants included Chinese, Filipino, and Japanese individuals who were aged 60 to less than 90 years without a dementia diagnosis in the EHR at the time of the survey (baseline) and who had 2 years of health plan coverage before baseline. Data analysis was performed from December 2021 to December 2022. EXPOSURES The main exposure was educational attainment (college degree or higher vs less than a college degree), and the main stratification variables were Asian ethnicity and nativity (born in the US or born outside the US). MAIN OUTCOMES AND MEASURES The primary outcome was incident dementia diagnosis in the EHR. Dementia incidence rates were estimated by ethnicity and nativity, and Cox proportional hazards and Aalen additive hazards models were fitted for the association of college degree or higher vs less than a college degree with time to dementia, adjusting for age (timescale), sex, nativity, and an interaction between nativity and college degree. RESULTS Among 14 749 individuals, the mean (SD) age at baseline was 70.6 (7.3) years, 8174 (55.4%) were female, and 6931 (47.0%) had attained a college degree. Overall, among individuals born in the US, those with a college degree had 12% lower dementia incidence (HR, 0.88; 95% CI, 0.75-1.03) compared with those without at least a college degree, although the confidence interval included the null. The HR for individuals born outside the US was 0.82 (95% CI, 0.72-0.92; P = .46 for the college degree by nativity interaction). The findings were similar across ethnicity and nativity groups except for Japanese individuals born outside the US. CONCLUSIONS AND RELEVANCE These findings suggest that college degree attainment was associated with lower dementia incidence, with similar associations across nativity. More work is needed to understand determinants of dementia in Asian American individuals and to elucidate mechanisms linking educational attainment and dementia.
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Affiliation(s)
- Eleanor Hayes-Larson
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Ryo Ikesu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Joseph Fong
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Taylor M. Mobley
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Ron Brookmeyer
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento
- Alzheimer’s Disease Center, University of California, Davis Health, Sacramento
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Mobley TM, Shaw C, Hayes-Larson E, Fong J, Gilsanz P, Gee GC, Brookmeyer R, Whitmer RA, Casey JA, Rose Mayeda E. Neighborhood disadvantage and dementia incidence in a cohort of Asian American and non-Latino White older adults in Northern California. Alzheimers Dement 2023; 19:296-306. [PMID: 35388625 PMCID: PMC9535033 DOI: 10.1002/alz.12660] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Some evidence suggests that neighborhood socioeconomic disadvantage is associated with dementia-related outcomes. However, prior research is predominantly among non-Latino Whites. METHODS We evaluated the association between neighborhood disadvantage (Area Deprivation Index [ADI]) and dementia incidence in Asian American (n = 18,103) and non-Latino White (n = 149,385) members of a Northern California integrated health care delivery system aged 60 to 89 at baseline. Race/ethnicity-specific Cox proportional hazards models adjusted for individual-level age, sex, socioeconomic measures, and block group population density estimated hazard ratios (HRs) for dementia. RESULTS Among non-Latino Whites, ADI was associated with dementia incidence (most vs. least disadvantaged ADI quintile HR = 1.09, 95% confidence interval [CI] = 1.02-1.15). Among Asian Americans, associations were close to null (e.g., most vs. least disadvantaged ADI quintile HR = 1.01, 95% CI = 0.85-1.21). DISCUSSION ADI was associated with dementia incidence among non-Latino Whites but not Asian Americans. Understanding the potentially different mechanisms driving dementia incidence in these groups could inform dementia prevention efforts.
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Affiliation(s)
- Taylor M. Mobley
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Crystal Shaw
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
- Department of Biostatistics, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Eleanor Hayes-Larson
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Joseph Fong
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Ron Brookmeyer
- Department of Biostatistics, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Rachel A. Whitmer
- Kaiser Permanente Division of Research, Oakland, CA
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
- Alzheimer’s Disease Center, University of California Davis Health, Sacramento, CA, USA
| | - Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Ashford MT, Raman R, Miller G, Donohue MC, Okonkwo OC, Mindt MR, Nosheny RL, Coker GA, Petersen RC, Aisen PS, Weiner MW. Screening and enrollment of underrepresented ethnocultural and educational populations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). Alzheimers Dement 2022; 18:2603-2613. [PMID: 35213778 PMCID: PMC9402812 DOI: 10.1002/alz.12640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An analysis of the ethnocultural and socioeconomic composition of Alzheimer's Disease Neuroimaging Initiative (ADNI) participants is needed to assess the generalizability of ADNI data to diverse populations. METHODS ADNI data collected between October 2004 and November 2020 were used to determine ethnocultural and educational composition of the sample and differences in the following metrics: screening, screen fails, enrollment, biomarkers. RESULTS Of 3739 screened individuals, 11% identified as being from ethnoculturally underrepresented populations (e.g., Black, Latinx) and 16% had <12 years of education. Of 2286 enrolled participants, 11% identified as ethnoculturally underrepresented individuals and 15% had <12 years of education. This participation is considerably lower than US Census data for adults 60+ (ethnoculturally underrepresented populations: 25%; <12 years of education: 4%). Individuals with <12 years of education failed screening at a higher rate. DISCUSSION Our findings suggest that ADNI results may not be entirely generalizable to ethnoculturally diverse and low education populations.
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Affiliation(s)
- Miriam T. Ashford
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center - San Francisco (United States)
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Garrett Miller
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael C. Donohue
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research Center and The Department of Medicine, University of Wisconsin School Of Medicine And Public Health - Madison (United States)
| | - Monica Rivera Mindt
- Psychology & Latin American Latino Studies Institute, Fordham University, Joint Appointment in Neurology, Icahn School of Medicine at Mount Sinai - New York (United States)
| | - Rachel L. Nosheny
- Department Of Psychiatry, University of California San Francisco - San Francisco (United States)
| | - Godfrey A. Coker
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | | | - Paul S. Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael W. Weiner
- Department Of Radiology and Biomedical Imaging, University of California San Francisco - San Francisco (United States)
| | - Alzheimer’s Disease Neuroimaging Initiative
- Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). A complete listing of ADNI investigators can be found at:http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf
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15
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Wilkins CH, Windon CC, Dilworth-Anderson P, Romanoff J, Gatsonis C, Hanna L, Apgar C, Gareen IF, Hill CV, Hillner BE, March A, Siegel BA, Whitmer RA, Carrillo MC, Rabinovici GD. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) Cohort Study. JAMA Neurol 2022; 79:2796653. [PMID: 36190710 PMCID: PMC9531087 DOI: 10.1001/jamaneurol.2022.3157] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023]
Abstract
Importance Racial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET). Objective To compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia. Design, Setting, and Participants Secondary analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups. Exposures In the IDEAS study, participants underwent a single amyloid PET scan. Main Outcomes and Measures The main outcomes were amyloid PET positivity proportions and odds. Results Data from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P < .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P < .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P < .001) compared with White participants. Conclusions and Relevance Racial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.
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Affiliation(s)
- Consuelo H. Wilkins
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles C. Windon
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | - Andrew March
- Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente, Oakland, California
- Department of Public Health Sciences, University of California, Davis
| | | | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
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16
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Hayes-Larson E, Fong J, Mobley TM, Gilsanz P, Whitmer RA, Gee GC, Brookmeyer R, Mayeda ER. The role of nativity in heterogeneous dementia incidence in a large cohort of three Asian American groups and white older adults in California. Alzheimers Dement 2022; 18:1580-1585. [PMID: 35103385 PMCID: PMC9339576 DOI: 10.1002/alz.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Literature shows lower dementia incidence in Asian American groups versus whites, varying by Asian ethnicity. One hypothesized driver is nativity differences (eg, healthy immigrant effect). METHODS We followed a cohort of 6243 Chinese, 4879 Filipino, 3256 Japanese, and 141,158 white Kaiser Permanente Northern California members for incident dementia (2002 to 2020), estimating age-adjusted dementia incidence rates by ethnicity and nativity, and hazard ratios (HR) for nativity on dementia incidence using ethnicity-stratified age- and sex-adjusted Cox proportional hazards models. RESULTS Dementia incidence appeared higher in foreign- versus US-born Filipinos (HR, 95% confidence interval: 1.39, 1.02 to 1.89); differences were small in Japanese (1.07, 0.88 to 1.30) and Chinese (1.07, 0.92 to 1.24). No nativity differences were observed among whites (1.00, 0.95 to 1.04). DISCUSSION Nativity does not explain lower dementia incidence in Asian Americans versus whites, but may contribute to heterogeneity across Asian ethnicities. Future research should explore differential impacts of social and cardiometabolic factors.
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Affiliation(s)
- Eleanor Hayes-Larson
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Joseph Fong
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Taylor M. Mobley
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Rachel A. Whitmer
- Alzheimer’s Disease Center, University of California, Davis, Sacramento, California, USA,Department of Public Health Sciences, University of California, Davis, California, USA
| | - Gilbert C. Gee
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ron Brookmeyer
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA,Corresponding author contact information: 650 Charles E Young Dr. CHS 46-070, Los Angeles, CA 90095, , Ph: 310-825-5234 Fax: 310-206-6039
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Li M, Lu SE, Hoover DR, Flynn L, Silverstein M, Wu B, Dong X. Family type and cognitive function in older Chinese Americans: acculturation as a moderator. Aging Ment Health 2022; 26:1642-1653. [PMID: 34038643 PMCID: PMC8718330 DOI: 10.1080/13607863.2021.1926426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Acculturation to the mainstream culture and the settlement contexts could shape cognitive function of older immigrants. Guided by ecological theory, this study examines the interaction effect between individual acculturation and ecology of family on cognitive function among older Chinese Americans. METHODS Data were derived from the Population Study of Chinese Elderly in Chicago (n = 3,019). Family types included tight-knit (high solidarity and low conflicts), unobligated-ambivalent (high solidarity and conflicts), commanding-conflicted (low solidarity and high conflicts), and detached (low solidarity and low conflicts). Acculturation was measured via language ability, media use, and ethnic social relations. Cognitive function was evaluated by global cognition, episodic memory, working memory, processing speed, and mini-mental state examination. Multiple regression analyses and interaction terms were used. RESULTS Older adults in the commanding-conflicted type had the lowest cognitive function. After controlling confounding variables, higher levels of acculturation (b = 0.009, SE = 0.003, p < .01) were associated with higher levels of global cognition. Acculturation buffered the negative impact of having a commanding-conflicted relationship with children on global cognition (b = 0.070, SE = 0.016, p < .001). Language ability, media use, and ethnic social relations played a unique role in the relationships between family types and cognitive domains. CONCLUSION Acculturation to the dominant culture is identified as a cultural asset for cognitive function in older Chinese Americans. Social services could protect cognitive function of older immigrants in the commanding-conflicted type through enhancing cultural participation. Future research could test how affective and cognitive aspects of acculturation affect health.
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Affiliation(s)
- Mengting Li
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey,School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Shou-En Lu
- School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Donald R. Hoover
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Linda Flynn
- School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Merril Silverstein
- Department of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York,Department of Human Development and Family Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
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18
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Affiliation(s)
- Gwen Yeo
- Stanford University School of Medicine, Stanford, California
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19
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Nguyen ML, Huie EZ, Whitmer RA, George KM, Dugger BN. Neuropathology Studies of Dementia in US Persons other than Non-Hispanic Whites. FREE NEUROPATHOLOGY 2022; 3. [PMID: 35425946 PMCID: PMC9007571 DOI: 10.17879/freeneuropathology-2022-3795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia are two of the most prevalent dementias that afflict the aging population in the United States (US). Studies have made great strides in understanding the neuropathology of these diseases; however, many studies are conducted in the context of non-Hispanic whites (NHWs), and few include the rapidly growing underrepresented populations that reside in the US. We sought to characterize current knowledge of the neuropathologic landscape of AD and vascular dementia of the largest growing US minority groups, namely Latinos/Hispanics, Black Americans, and Asian Americans, compared with NHWs being the majority group. It is vital to note these historic categories are social constructs and cultural and social associations may underlie differences. We conducted a literature search utilizing specific criteria to yield neuropathology papers that addressed the demographics and neuropathologies of relevance, then collated the findings into this review. We reveal that while there has been much progress in neuropathological research involving Latinos/Hispanics and Black Americans in the past decade, no cohesive conclusions could be extrapolated from the existing data due to the dearth of minority participants and even smaller amount of information related to the heterogeneity within each minority group, especially Latinos/Hispanics. Furthermore, we reveal an even greater scarcity in neuropathological studies involving Asian Americans, also a very heterogeneous group. We hope the presented findings will illuminate the paucity of minority representation in not just neuropathological research but the field of clinical research overall and serve to inspire clinicians and researchers to help reduce the health disparities underrepresented groups in the US face.
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Affiliation(s)
- My-le Nguyen
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Emily Z Huie
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, University of California, Davis
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20
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Kanaya AM, Hsing AW, Panapasa SV, Kandula NR, Araneta MRG, Shimbo D, Wang P, Gomez SL, Lee J, Narayan KMV, Mau MKLM, Bose S, Daviglus ML, Hu FB, Islam N, Jackson CL, Kataoka-Yahiro M, Kauwe JSK, Liu S, Ma GX, Nguyen T, Palaniappan L, Setiawan VW, Trinh-Shevrin C, Tsoh JY, Vaidya D, Vickrey B, Wang TJ, Wong ND, Coady S, Hong Y. Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Ann Intern Med 2022; 175:574-589. [PMID: 34978851 PMCID: PMC9018596 DOI: 10.7326/m21-3729] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.
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Affiliation(s)
- Alka M Kanaya
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Ann W Hsing
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | | | | | | | - Daichi Shimbo
- Columbia University Irving Medical Center, New York, New York (D.S.)
| | - Paul Wang
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | - Scarlett L Gomez
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Jinkook Lee
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | | | | | - Sonali Bose
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | | | - Frank B Hu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (F.B.H.)
| | - Nadia Islam
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Chandra L Jackson
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland (C.L.J.)
| | | | | | - Simin Liu
- Brown University, Providence, Rhode Island (S.L.)
| | - Grace X Ma
- Temple University, Philadelphia, Pennsylvania (G.X.M.)
| | - Tung Nguyen
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - V Wendy Setiawan
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | - Chau Trinh-Shevrin
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | - Thomas J Wang
- University of Texas Southwestern Medical Center, Dallas, Texas (T.J.W.)
| | - Nathan D Wong
- University of California, Irvine, Irvine, California (N.D.W.)
| | - Sean Coady
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
| | - Yuling Hong
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
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21
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
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22
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Đoàn LN, Takata Y, Hooker K, Mendez-Luck C, Irvin VL. Trends in Cardiovascular Disease by Asian American, Native Hawaiian, and Pacific Islander Ethnicity, Medicare Health Outcomes Survey 2011-2015. J Gerontol A Biol Sci Med Sci 2022; 77:299-309. [PMID: 34491324 PMCID: PMC8824666 DOI: 10.1093/gerona/glab262] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) is increasing in the aging population. However, little is known about CVD risk factors and outcomes for Asian American, Native Hawaiian, and Other Pacific Islander (NH/PI) older adults by disaggregated subgroups. METHODS Data were from the Centers for Medicare and Medicaid Services 2011-2015 Health Outcomes Survey, which started collecting expanded racial/ethnic data in 2011. Guided by Andersen and Newman's theoretical framework, multivariable logistic regression analyses were conducted to examine the prevalence and determinants of CVD risk factors (obesity, diabetes, smoking status, hypertension) and CVD conditions (coronary artery disease [CAD], congestive heart failure [CHF], myocardial infarction [MI], other heart conditions, stroke) for 10 Asian American and NH/PI subgroups and White adults. RESULTS Among the 639 862 respondents, including 26 853 Asian American and 4 926 NH/PI adults, 13% reported CAD, 7% reported CHF, 10% reported MI, 22% reported other heart conditions, and 7% reported stroke. CVD risk factors varied by Asian American and NH/PI subgroup. The prevalence of overweight, obesity, diabetes, and hypertension was higher among most Asian American and NH/PI subgroups than White adults. After adjustment, Native Hawaiians had significantly greater odds of reporting stroke than White adults. CONCLUSIONS More attention should focus on NH/PIs as a priority population based on the disproportionate burden of CVD risk factors compared with their White and Asian American counterparts. Future research should disaggregate racial/ethnic data to provide accurate depictions of CVD and investigate the development of CVD risk factors in Asian Americans and NH/PIs over the life course.
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Affiliation(s)
- Lan N Đoàn
- School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
- Department of Population Health Section for Health Equity, NYU Grossman School of Medicine, New York, New York, USA
| | - Yumie Takata
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences Oregon State University, Corvallis, Oregon, USA
| | - Karen Hooker
- School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Carolyn Mendez-Luck
- School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Veronica L Irvin
- School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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23
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Bothongo PL, Jitlal M, Parry E, Waters S, Foote IF, Watson CJ, Cuzick J, Giovannoni G, Dobson R, Noyce AJ, Mukadam N, Bestwick JP, Marshall CR. Dementia risk in a diverse population: A single-region nested case-control study in the East End of London. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100321. [PMID: 35558994 PMCID: PMC9088197 DOI: 10.1016/j.lanepe.2022.100321] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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24
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Bennett EE, Kwan A, Gianattasio KZ, Engelman B, Dowling NM, Power MC. Estimation of dementia prevalence at the local level in the United States. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12237. [PMID: 35005210 PMCID: PMC8719342 DOI: 10.1002/trc2.12237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Ensuring adequate and equitable distribution of resources to support persons living with dementia relies on understanding the burden and distribution of dementia in a population. Our goal was to develop an approach to estimate dementia prevalence at the local level in the United States using publicly available data. METHODS Our approach combines publicly available data on dementia prevalence and demographic data from the US Census to estimate dementia prevalence. We illustrate this approach by estimating dementia prevalence in persons aged 65 and older in Philadelphia, PA; Chicago, IL; and Atlanta, GA. RESULTS Overall, we estimate the prevalence of dementia among those 65 and older to be 11.9% in Philadelphia, 11.8% Chicago, and 12.3% in Atlanta. Estimates across Philadelphia localities vary from 9.3% to 15.9%. DISCUSSION Our approach provides a cost-effective method to generate estimates of dementia prevalence at the local level. HIGHLIGHTS Brain health needs assessments require understanding of local dementia prevalence.Our approach can be used to estimate dementia prevalence in individual communities.This information can inform decisions about distribution of resources.
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Affiliation(s)
- Erin E. Bennett
- Department of Epidemiology, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Abraham Kwan
- Department of Epidemiology, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Kan Z. Gianattasio
- Department of Epidemiology, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Brittany Engelman
- Department of Epidemiology, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - N. Maritza Dowling
- Department of Acute and Chronic Care, School of NursingGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Melinda C. Power
- Department of Epidemiology, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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25
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Dixon JS, Coyne AE, Duff K, Ready RE. Predictors of cognitive decline in a multi-racial sample of midlife women: A longitudinal study. Neuropsychology 2021; 35:514-528. [PMID: 34014752 PMCID: PMC8352567 DOI: 10.1037/neu0000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Hypertension, diabetes, depressive symptoms, and smoking are predictors of cognitive decline in late life. It is unknown if these risk factors are associated with cognition during midlife or if the associations between these risk factors and cognition vary by race. This longitudinal study examined (a) risk factors for decline in episodic memory, processing speed, and working memory in midlife women and (b) if the associations between risk factors and cognitive decline were moderated by race. Method: Participants (aged 42-52) were European American (n = 1,000), African American (n = 516), and Asian American (n = 437) women from the Study of Women's Health Across the Nation. Two-level hierarchical linear models tested risk factors, race, and their interactions as predictors of cognitive change over time. Results: African Americans had poorer baseline episodic memory, processing speed, and working memory and greater episodic memory decline compared to European Americans. Asian Americans had poorer episodic memory and working memory, but better processing speed than European Americans. Depressive symptoms were associated with poorer episodic memory and processing speed at baseline; further, diabetes was associated with poorer processing speed at baseline. Greater depressive symptoms were associated with poorer episodic memory at baseline for African Americans but not European Americans. Conclusions: Our study results highlight racial disparities in cognition during midlife. Depressive symptoms may be particularly detrimental to the cognitive health of African Americans. Clinical and public health interventions for healthy cognitive aging should be tailored to the unique risks of racial groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jasmine S. Dixon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Alice E. Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - Rebecca E. Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
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26
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Tsoy E, Kiekhofer RE, Guterman EL, Tee BL, Windon CC, Dorsman KA, Lanata SC, Rabinovici GD, Miller BL, Kind AJH, Possin KL. Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California. JAMA Neurol 2021; 78:657-665. [PMID: 33779684 PMCID: PMC8008426 DOI: 10.1001/jamaneurol.2021.0399] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022]
Abstract
Importance The US aging population is rapidly becoming more racially and ethnically diverse. Early diagnosis of dementia is a health care priority. Objective To examine the associations between race/ethnicity and timeliness of dementia diagnosis and comprehensiveness of diagnostic evaluation. Design, Setting, and Participants This retrospective cross-sectional study used 2013-2015 California Medicare fee-for-service data to examine the associations of race/ethnicity, individual factors, and contextual factors with the timeliness and comprehensiveness of dementia diagnosis. Data from 10 472 unique beneficiaries were analyzed. The sample was selected on the basis of the following criteria: presence of 1 or more claims; no diagnoses of dementia or mild cognitive impairment in 2013 to 2014; continuous enrollment in Medicare Parts A and B; Asian, Black, Hispanic, or White race/ethnicity; and incident diagnoses of dementia or mild cognitive impairment in January through June 2015. Data analyses were conducted from November 1, 2019, through November 10, 2020. Main Outcomes and Measures Timeliness of diagnosis, defined as incident diagnosis of mild cognitive impairment vs dementia, and comprehensiveness of diagnostic evaluation, defined as presence of the following services in claims within 6 months before or after the incident diagnosis date: specialist evaluation, laboratory testing, and neuroimaging studies. Results The sample comprised 10 472 unique Medicare beneficiaries with incident diagnoses of dementia or mild cognitive impairment (6504 women [62.1%]; mean [SD] age, 82.9 [8.0] years) and included 993 individuals who identified as Asian (9.5%), 407 as Black (3.9%), 1255 as Hispanic (12.0%), and 7817 as White (74.6%). Compared with White beneficiaries, those who identified as Asian (odds ratio, 0.46; 95% CI, 0.38-0.56), Black (odds ratio, 0.73; 95% CI, 0.56-0.94), or Hispanic (odds ratio, 0.62; 95% CI, 0.52-0.72) were less likely to receive a timely diagnosis. Asian beneficiaries (incidence rate ratio, 0.81; 95% CI, 0.74-0.87) also received fewer diagnostic evaluation elements. These associations remained significant after adjusting for age, sex, comorbidity burden, neighborhood disadvantage, and rurality. Conclusions and Relevance These findings highlight substantial disparities in the timeliness and comprehensiveness of dementia diagnosis. Public health interventions are needed to achieve equitable care for people living with dementia across all racial/ethnic groups.
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Affiliation(s)
- Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Rachel E. Kiekhofer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Elan L. Guterman
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Charles C. Windon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Karen A. Dorsman
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas
| | - Serggio C. Lanata
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Global Brain Health Institute, University of California, San Francisco, San Francisco
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
- Associate Editor, JAMA Neurology
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Global Brain Health Institute, University of California, San Francisco, San Francisco
| | - Amy J. H. Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatrics Research Education and Clinical Center, Madison Veterans Affairs Hospital, Madison, Wisconsin
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Global Brain Health Institute, University of California, San Francisco, San Francisco
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27
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.
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28
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Shiekh SI, Cadogan SL, Lin LY, Mathur R, Smeeth L, Warren-Gash C. Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 80:337-355. [PMID: 33554910 PMCID: PMC8075390 DOI: 10.3233/jad-201209] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Globally around 50 million people have dementia. Risk factors for dementia such as hypertension and diabetes are more common in Black, Asian, and other ethnic minorities. There are also marked ethnic inequalities in care seeking, likelihood of diagnosis, and uptake of treatments for dementia. Nevertheless, ethnic differences in dementia incidence and prevalence remain under-explored. Objective: To examine published peer-reviewed observational studies comparing age-specific or age-adjusted incidence or prevalence rates of dementia between at least two ethnic groups. Methods: We searched seven databases on 1 September 2019 using search terms for ethnicity, dementia, and incidence or prevalence. We included population-based studies comparing incidence or prevalence of dementia after accounting for age of at least two ethnic groups in adults aged 18 or more. Meta-analysis was conducted for eligible ethnic comparisons. Results: We included 12 cohort studies and seven cross-sectional studies. Thirteen were from the US, and two studies each from the UK, Singapore, and Xinjiang Uyghur Autonomous Region in China. The pooled risk ratio for dementia incidence obtained from four studies comparing Black and White ethnic groups was 1.33 (95% CI 1.07–1.65; I-squared = 58.0%). The pooled risk ratio for dementia incidence comparing the Asian and White ethnic groups was 0.86 (95% CI 0.728–1.01; I-squared = 43.9%). There was no difference in the incidence of dementia for Latino ethnic group compared to the White ethnic group. Conclusion: Evidence to date suggest there are ethnic differences in risk of dementia. Better understanding of the drivers of these differences may inform efforts to prevent or treat dementia.
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Affiliation(s)
- Suhail Ismail Shiekh
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, The United Kingdom
| | - Sharon Louise Cadogan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, The United Kingdom
| | - Liang-Yu Lin
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, The United Kingdom
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, The United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, The United Kingdom
| | - Charlotte Warren-Gash
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, The United Kingdom
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29
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Herat-Gunaratne R, Cooper C, Mukadam N, Rapaport P, Leverton M, Higgs P, Samus Q, Burton A. "In the Bengali Vocabulary, There Is No Such Word as Care Home": Caring Experiences of UK Bangladeshi and Indian Family Carers of People Living With Dementia at Home. THE GERONTOLOGIST 2020; 60:331-339. [PMID: 31587053 DOI: 10.1093/geront/gnz120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to explore experiences of South Asian carers of people with dementia receiving health or social care in the United Kingdom, purposively recruited to encompass a range of migration, economic and cultural experiences. While previous work in this area has reported carers' understanding of, and attitudes to dementia, we explored how carers' cultural identities and values influenced their experiences, negotiation of the caring role and relationship with services. RESEARCH DESIGN AND METHODS We conducted semi-structured interviews with 10 Bangladeshi and Indian family carers of people living with dementia at home. We recruited participants from community settings in London and Bradford, UK. Interviews were audio recorded, transcribed and thematically analyzed. RESULTS We identified 4 themes: an expectation and duty to care, expectation and duty as a barrier to accessing formal care (family carer reluctance, care recipient reluctance, and service organization), culturally (in)sensitive care, and the importance of support from informal care networks. DISCUSSION AND IMPLICATIONS Interviewees described tensions between generations with different understandings of familial care obligations. Expectations to manage led to burden and guilt, and the cost of caring, in terms of lost employment and relationships was striking. Unlike in previous studies, interviewees wanted to engage and be supported by services, but were frequently offered care models they could not accept. There was a tension between a state-provided care system obliged to provide care when there are no alternatives, and family carers who feel a duty to always provide alternatives. Informal social networks often provided valued support.
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Affiliation(s)
| | - Claudia Cooper
- Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | - Paul Higgs
- Division of Psychiatry, University College London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
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30
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Ashford MT, Eichenbaum J, Williams T, Camacho MR, Fockler J, Ulbricht A, Flenniken D, Truran D, Mackin RS, Weiner MW, Nosheny RL. Effects of sex, race, ethnicity, and education on online aging research participation. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12028. [PMID: 32478165 PMCID: PMC7249268 DOI: 10.1002/trc2.12028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study aimed to identify the relationship of sociodemographic variables with older adults participation in an online registry for recruitment and longitudinal assessment in cognitive aging. METHODS Using Brain Health Registry (BHR) data, associations between sociodemographic variables (sex, race, ethnicity, education) and registry participation outcomes (task completion, willingness to participate in future studies, referral/enrollment in other studies) were examined in adults aged 55+ (N = 35,919) using logistic regression. All models included sex, race, ethnicity, education, age, and subjective memory concern. RESULTS Non-white race, being Latino, and lower educational attainment were associated with decreased task completion and enrollment in additional studies. Results for sex were mixed. DISCUSSION The findings provide novel information about engagement in online aging-related registries, and highlight a need to develop improved engagement strategies targeting underrepresented sociodemographic groups. Increasing registry diversity will allow researchers to refer more representative populations to Alzheimer's and related dementias prevention and treatment trials.
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Affiliation(s)
- Miriam T. Ashford
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Joseph Eichenbaum
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Tirzah Williams
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Monica R. Camacho
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Juliet Fockler
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Aaron Ulbricht
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Derek Flenniken
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Diana Truran
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - R. Scott Mackin
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Rachel L. Nosheny
- Department of Veterans Affairs Medical CenterCenter for Imaging and Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Ogliari G, Turner Z, Khalique J, Gordon AL, Gladman JRF, Chadborn NH. Ethnic disparity in access to the memory assessment service between South Asian and white British older adults in the United Kingdom: A cohort study. Int J Geriatr Psychiatry 2020; 35:507-515. [PMID: 31943347 DOI: 10.1002/gps.5263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Equality of access to memory assessment services by older adults from ethnic minorities is both an ethical imperative and a public health priority. OBJECTIVE To investigate whether timeliness of access to memory assessment service differs between older people of white British and South Asian ethnicity. DESIGN Longitudinal cohort. SETTING Nottingham Memory Study; outpatient secondary mental healthcare. SUBJECTS Our cohort comprised 3654 white British and 32 South Asian older outpatients. METHODS The criterion for timely access to memory assessment service was set at 90 days from referral. Relationships between ethnicity and likelihood of timely access to memory assessment service were analysed using binary logistic regression. Analyses were adjusted for socio-demographic factors, deprivation and previous access to rapid response mental health services. RESULTS Among white British outpatients, 2272 people (62.2%) achieved timely access to memory assessment service. Among South Asian outpatients, fourteen people (43.8%) achieved timely access to memory assessment service. After full adjustment, South Asian outpatients had a 0.47-fold reduced likelihood of timely access, compared to white British outpatients (odds ratio 0.47, 95% confidence interval 0.23-0.95, P value = .035). The difference became non-significant when restricting analyses to outpatients reporting British nationality or English as first language. Older age, lower index of deprivation and previous access to rapid response mental health services were associated with reduced likelihood of timely access, while gender was not. CONCLUSIONS In a UK mental healthcare service, older South Asian outpatients are less likely to access dementia diagnostic services in a timely way, compared to white British outpatients.
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Affiliation(s)
- Giulia Ogliari
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,Clinical Development Unit, Medical Directorate, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Zoë Turner
- Clinical Development Unit, Medical Directorate, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Javid Khalique
- Independent Community Engagement Consultant, Nottingham, UK
| | - Adam L Gordon
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Neil H Chadborn
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.
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Lim S, Mohaimin S, Min D, Roberts T, Sohn YJ, Wong J, Sivanesathurai R, Kwon SC, Trinh-Shevrin C. Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review. J Alzheimers Dis 2020; 77:523-537. [PMID: 32675416 PMCID: PMC8638681 DOI: 10.3233/jad-200509] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population. OBJECTIVE The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. METHODS The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. CONCLUSION To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine
| | - Sadia Mohaimin
- Department of Population Health, New York University Grossman School of Medicine
| | - Deborah Min
- Department of Population Health, New York University Grossman School of Medicine
| | - Timothy Roberts
- Health Science Library, New York University Grossman School of Medicine
| | - Young-Jin Sohn
- Department of Population Health, New York University Grossman School of Medicine
| | - Jazmine Wong
- Department of Population Health, New York University Grossman School of Medicine
| | | | - Simona C. Kwon
- Department of Population Health, New York University Grossman School of Medicine
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine
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Brewster P, Barnes L, Haan M, Johnson JK, Manly JJ, Nápoles AM, Whitmer RA, Carvajal-Carmona L, Early D, Farias S, Mayeda ER, Melrose R, Meyer OL, Zeki Al Hazzouri A, Hinton L, Mungas D. Progress and future challenges in aging and diversity research in the United States. Alzheimers Dement 2018; 15:995-1003. [PMID: 30240574 DOI: 10.1016/j.jalz.2018.07.221] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 12/31/2022]
Abstract
In 2016, the UC Davis Latino Aging Research Resource Center and UC Davis Alzheimer's Disease Center brought together experts from across the country to consolidate current knowledge and identify future directions in aging and diversity research. This report disseminates the research priorities that emerged from this conference, building on an earlier Gerontological Society of America preconference. We review key racial/ethnic differences in cognitive aging and dementia and identify current knowledge gaps in the field. We advocate for a systems-level framework for future research whereby environmental, sociocultural, behavioral, neuropathological, genetic, and psychometric levels of analysis are examined together to identify pathways and mechanisms that influence disparities. We then discuss steps to increase the recruitment and retention of racial/ethnic minorities in aging studies, as none of the recommendations will be possible without strong collaboration between racial/ethnic minority communities and researchers. This approach is consistent with the National Institute on Aging Health Disparities Research Framework.
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Affiliation(s)
- Paul Brewster
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, USA.
| | - Lisa Barnes
- Rush Alzheimer's Disease Center and Departments of Neurological Sciences and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, CA, USA
| | - Julene K Johnson
- Institute for Health & Aging, UC San Francisco, San Francisco, CA, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Anna María Nápoles
- Center for Aging in Diverse Communities, UC San Francisco, San Francisco, CA, USA
| | - Rachel A Whitmer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Luis Carvajal-Carmona
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Davis, CA, USA
| | - Dawnte Early
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Sarah Farias
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, CA, USA; University of California, Los Angeles Department of Epidemiology, Los Angeles, CA, USA
| | - Rebecca Melrose
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Oanh L Meyer
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Adina Zeki Al Hazzouri
- Division of Epidemiology and Population Health, Department of Public Health Science, University of Miami, Miami, FL, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA, USA
| | - Dan Mungas
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
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Pham TM, Petersen I, Walters K, Raine R, Manthorpe J, Mukadam N, Cooper C. Trends in dementia diagnosis rates in UK ethnic groups: analysis of UK primary care data. Clin Epidemiol 2018; 10:949-960. [PMID: 30123007 PMCID: PMC6087031 DOI: 10.2147/clep.s152647] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives We compared incidence of dementia diagnosis by white, black, and Asian ethnic groups and estimated the proportion of UK white and black people developing dementia in 2015 who had a diagnosis for the first time in a UK-wide study. Methods We analyzed primary care electronic health records from The Health Improvement Network database between 2007 and 2015 and compared incidence of dementia diagnosis to dementia incidence from community cohort studies. The study sample comprised of 2,511,681 individuals aged 50–105 years who did not have a dementia diagnosis prior to the start of follow-up. Results A total of 66,083 individuals had a dementia diagnosis (4.87/1,000 person-years at risk, 95% CI 4.83–4.90); this incidence increased from 3.75 to 5.65/1,000 person-years at risk between 2007 and 2015. Compared with white women, the incidence of dementia diagnosis was 18% lower among Asian women (adjusted incidence rate ratio (IRR) 0.82, 95% CI 0.72–0.95) and 25% higher among black women (IRR 1.25, 95% CI 1.07–1.46). For men, incidence of dementia diagnosis was 28% higher in the black ethnic group (IRR 1.28, 95% CI 1.08–1.50) and 12% lower in the Asian ethnic group (IRR 0.88, 95% CI 0.76–1.01) relative to the white ethnic group. Based on diagnosis incidence in The Health Improvement Network data and projections of incidence from community cohort studies, we estimated that 42% of black men developing dementia in 2015 were diagnosed compared with 53% of white men. Conclusion People from the black ethnic group had a higher incidence of dementia diagnosis and those from the Asian ethnic group had lower incidence compared with the white ethnic group. We estimated that black men developing dementia were less likely than white men to have a diagnosis of dementia, indicating that the increased risk of dementia diagnosis reported in the black ethnic group might underestimate the higher risk of dementia in this group. It is unclear whether the lower incidence of dementia diagnosis in the Asian ethnic group reflects lower community incidence or underdiagnosis. A cohort study to determine this is needed.
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Affiliation(s)
- Tra My Pham
- Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK,
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK,
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