New study finds Alzheimer’s warning sign appears earlier in these demographics

The latest research into a well-known early warning sign for Alzheimer’s disease shows a disturbing way in which certain populations may be most at risk of cognitive decline — specifically people who identify as black or Hispanic.

The early warning sign in question, known as subjective cognitive decline, is characterized by “the self-reported experience of worsening or more frequent confusion or memory loss.” It’s also one of the earliest signs of Alzheimer’s disease and related dementias.

What’s new — The new study, led by Sangeeta Gupta at Delaware State University, looks at subjective cognitive decline affects people across demographics, especially racial and ethnic minorities, and comes to a disturbing conclusion: communities that already carry a disproportionate burden of chronic illness are most at-risk.

The results, published Wednesday in the journal BioMed Central, should galvanize public health officials into action.

Why focus on racial and ethnic minorities?— SCD plays an outsized role in the lives of those who manifest the symptoms:

• It affects people’s ability to work, household chores, take medications, and other day-to-day business
• It’s also frequently correlated with morbidities like stroke, heart attack, and high blood pressure
• When a person has SCD in addition to one of those morbidities, their chance of developing Alzheimer’s disease and related dementias (ADRD) increases

But why focus on specific racial and ethnic demographics in the United States?

Gupta gives Inverse her five reasons:

1. Minority populations are projected to rise to 56 percent of the total U.S. population in 2060. By 2060, minority populations over 65 years old will represent 45 percent of the U.S. population, which is up from 22 percent in 2014.
2. The burden of age-related chronic conditions, such as Alzheimer's disease and related dementias (ADRD) are thus projected to disproportionately impact minorities, both in terms of prevalence and severity.
3. Minority communities are more vulnerable as regards the social determinants of health- more likely to experience limited access to health care, lower level of education, less income, and loneliness/ lack of social support.
4. Minority populations also bear a disparate burden of certain chronic disorders such as heart disease and diabetes that are associated with a higher risk for ADRD.
5. This is a population-based study exploring in detail ethnoracial disparities related to subjective cognitive decline (SCD). Population‐based measures of SCD can be extremely useful to the public health community, health care providers, and policymakers in prioritization and planning efforts.

For these reasons, Gupta tells Inverse, “it is vital to put a spotlight on cognitive impairment-related disparities that may exist among minority communities.”

What she did—Gupta analyzed data from 179,852 adults in the United States aged 45 or older. The data had been collected from 2015 to 2018 as part of the Behavioral Risk Factor Surveillance System, which is a huge, health-related national survey.

Respondents in all 50 states plus U.S. territories, District of Columbia, and Puerto Rico, answered six questions designed to self-assess memory loss and cognitive ability.

Gupta took all the responses from people who had reported SCD and grouped them by age, health, and race/ethnicity, and then analyzed that population-level data.

What she found–The evidence was striking: “Minority groups in the US are more vulnerable to memory loss, confusion and their consequences earlier in life,” Gupta says.

Specifically:

• Black and Hispanic individuals with SCD were more likely to be younger, in their mid-forties to mid-fifties, compared to white individuals with SCD, most of whom were 65 and older.
• Blacks and Hispanics with SCD have a significantly higher burden of chronic conditions and adverse social determinants than their white counterparts, predicting worse cognitive health outcomes.
• SCD-associated functional limitations such as the ability to perform household chores, social activities, work, etc., were also found to be significantly higher in Hispanics and Blacks compared to whites, foretelling a need for increased support from caregivers.

While all of these results have significant implications for the healthcare system, economists should take note as well.

“Adults aged between 45–54 years are at the peak of their careers regards to salary, productivity, and contributions to their retirements. SCD may lead to functional limitations that have a substantial social and economic impact on these individuals and their families,” Gupta says.

The study also found that less than 50 percent of the minority groups had discussed their SCD with a healthcare provider, though that wasn’t significantly different from the white population. That said, the association of ADRD with dependence and disability for a long duration- earlier detection is of paramount importance.

What’s driving the association between SCD and minorities in the U.S.?— Gupta believes there are two primary factors:

• Adverse social determinants faced by minority communities. According to the CDC social determinants are shaped by “money, power, and resources that people have,” and can be “subject to policy choices.”
• This lack of access to healthcare can result in ethnic and racial minorities having a higher burden of chronic conditions, which are cognitive risk factors, than their white counterparts.

What it means for the future—Gupta says she hopes the study results will help “public health stakeholders make data-driven decisions and be better prepared for the challenges associated with disparities in cognitive decline.”

For example, these communities could benefit from culturally sensitive, realistic, and effective outreach and screening efforts. Healthcare providers beginning a dialogue with family members and other caregivers about SCD, what to watch for in its progression, and starting to think about a plan if it turns into ADRD.

The healthcare of people with SCD matters to all of us. It affects the healthcare system, the economy, and very likely, our own family. Hopefully, studies like Gupta’s will make people with power investigate and remedy the systemic forces that make ethnoracial minorities so disproportionately affected by the condition.

Abstract: Subjective cognitive decline (SCD), characterized by self-experience of deterioration in cognitive performance may be a precursor to Alzheimer’s disease (AD). Given the association of AD with dependence and disability for a long duration, earlier the detection, the sooner people and their families can receive information regarding better management. It is critical to explore disparities amongst racial and ethnic populations with SCD in order to facilitate targeted interventions. The primary objective was to identify disparities in prevalence of SCD amongst Whites, Blacks and Hispanics by select sociodemographic characteristics and functional limitations in a U.S. population-based sample of non-institutionalized adults aged 45 and older. The secondary objective was to assess the association between SCD and select chronic conditions (angina, heart attack, stroke, diabetes, high blood pressure and high cholesterol) by race/ethnicity.