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Alzheimer’s Disease: Racism Impact on Black Health

By Dianne Anderson

Alzheimer’s and dementia can take decades to show up, but there is no time like the present to start working on healthier lifestyles. Compared to whites, Blacks get the disease twice as much, but another issue is at play.

Expert Dr. April Thames said the community, especially Blacks being most impacted, must get an early — and the right — diagnosis.

“What I think we see a lot is vascular dementia is ignored and it’s getting misdiagnosed as Alzheimer’s disease,” said Dr. Thames, Professor of Psychiatry, Chief Psychologist for the Division of Adult Psychiatry, and Director of the Social Neuroscience and Health Psychology Laboratory at UCLA.

She said testing is important as there are several types of dementia – the Alzheimer’s type, the vascular type, frontotemporal dementia, and HIV dementia, to name a few. Patients and caregivers should expect an extensive workup.

At one time, Dr. Thames said Alzheimer’s was thought to be the most common dementia marked by initial memory loss. But, research shows other signs of memory loss happen first with vascular dementia, like forgetting what’s on the tip of the tongue, planning, or multitasking.

“In cases of vascular dementia, what goes first is not really memory, but retrieving information, versus Alzheimer’s, which is more of an initial rapid forgetting of information,” she said.

Addressing vascular dementia early on can improve outcomes. Vascular health is related to blood flow and brain health, she said, which can lead to inflammation and brain fog that mimics Alzheimer’s.

“Vascular, that’s the one where I don’t like say reversible, but it goes back to where they were at. If you catch it early enough and someone is able to correct their diet and lifestyle, it can reduce the [mini-strokes], which means lack of blood flow in a certain area of the brain,” she said.

She said neurologists order imaging, examine the cerebral spinal fluid, along with cognitive testing, including biological pathology to determine levels of amyloid.

“Those things have to be seen clinically to know that this is an accurate diagnosis. More research is needed, but that’s why I think people are saying it’s Alzheimer’s, but it’s probably vascular dementia,” she said.

However, enough data exists to show pre-existing conditions, heart disease, or cancer has a close connection to developing Alzheimer’s from the 40s into the 60s.

“This is where we need more research into this connection, but we know people with chronic uncontrolled medical conditions, uncontrolled blood pressure, diabetes, overweight, all that is going to affect the way blood flows through organs,” she said.

Chronic medical conditions impact how blood throws through organs, how oxygen flows through the blood, and how it gets to the brain.

“The brain is [an organ] rich with blood supply. So if someone doesn’t have control, we see a lot of these mini-strokes in the brain, which is where there has been a lack of oxygen,” she said.

Other triggers for Alzheimer’s are a lifetime of stress and a lack of resources, according to recent studies.

“This has a whole host of what I think is racism within healthcare. I think it’s that doctors are not screening enough for us, by the time that any assessment of cognitive status occurs, the person is pretty late in the disease stage,” she said.

Blacks are more susceptible to what is considered modifiable risk factors, such as high blood pressure, diabetes, overweight, heart disease, and cancer, all linked to developing Alzheimer’s from the 40s into the 60s.

But one risk factor that seems hardest to modify is the impact of long-term racism.

According to one recent Alzheimer’s Association study, racism is directly correlated with cognitive decline. Of 1,000 participants, 55% Latinx; 23% Black; 19% White, racism was associated with lower memory scores, mostly impacting Black individuals. For Asian, Black, Latino, White and multiracial people age 90 and above, individuals that lived through wide-ranging discrimination had lower semantic memory in late life compared to those who experienced little to no discrimination.

Black participants were most exposed to racism at all levels, more likely to have lived in segregated areas and deprived of resources, the findings show. Exposure to civil rights violations and discrimination was associated with lower memory scores.

“Chronic exposure to racism and interpersonal discrimination among marginalized communities leads to stress that affects the body and influences physiological health, and likely contributes to the development of cognitive decline,” said Jennifer Manly, Ph.D., professor of Neuropsychology at Columbia University Irving Medical Center and the senior author of this work. “Overall, our findings indicate that racism impacts brain health and contributes to the unfair burden of Alzheimer’s disease in marginalized groups.”

Tia Delaney, a registered nurse in the community and a long-time consultant, said that Black Americans are affected by Alzheimer’s at a disturbing pace.

“We develop it twice as muich as any other ethnicity and women make up two-thirds of that population. But 21.7% of our African American seniors over age 70 will have some form of Alzheimer’s disease or dementia by 2030, 25% of our senior community. That’s overwhelming,” said Delaney, Director of Diversity, Equity & Inclusion for the Alzheimer’s Association, California Southland.

She works with local community members, nonprofits and faith-based organizations to get the word out on the need for early testing. Almost everyone knows someone in the community struggling with Alzheimer’s or another form of dementia, and she said it’s urgent to get resources within their reach.

As a nurse, she sees many risk factors with some forms of dementia with a direct connection to lack of nutrition in food deserts, toxic environments, low socioeconomic status and lack of decent healthcare, which disproportionately impacts African Americans and people of color.

It’s a perfect storm.

“The next step is having clinicians and healthcare facilities with cultural awareness, sensitivity and competency, and don’t have those structural barriers in place so people can get assessed and diagnosed,” she said.

In the community, even of those able to get diagnosed with the first signs of dementia, she said 80% of Black Americans report barriers to excellent healthcare and support.

It’s not a simple test. Those with Alzheimer’s or dementia should be referred to a geriatrician, a neurologist and given pet scan imaging that shows amyloid plaque build up in the brain for proper diagnosis.

Her outreach wants to educate the community on how waiting too long is dangerous – even if it isn’t Alzheimer’s and vascular-related.

“The numbers are so impactful in our community because we are diagnosing later in the terminal progression of the disease. It [impact] seems faster because we haven’t caught it at the earlier stage,” she said.

While Alzheimer’s is Neuro-degenerative, the good news is that if someone has the Alzheimer’s gene, APOE4, not everyone with that gene develops the disease.

Recently, the new Leqembi drug was approved by the FDA for reducing Amyloid plaque in the brain. It’s not a cure and has side effects, bleeding of the brain, but is reported to reduce memory loss in Alzheimer’s patients by 27%.

Delaney feels it now opens the doors for newer medications on the horizon.

“It may have side effects, but this means now we’re going to build off that, maybe in our lifetime or our children’s lifetime. There may be something that can make this disease dormant,” she said.

Usually, there is confusion around how Alzheimer’s or dementia progresses. She wants to establish new local partnerships, collaborations in the community to work with churches, faith-based organizations, and smaller nonprofits.

“Reach out to the Alzheimer’s Association to see how we can help you in those categories,” she said. “You might decide you need to be part of a support group, and you can access resources 24/7 live and on the website. We want to make sure that we’re available when you need us.”

For more information, see

Alzheimer’s Association Website:

Community Resource Finder –

See the Alzheimer’s racism study,

Learn how to reduce the risk of Alzheimer’s disease,

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