Black and poorer Americans are less likely to receive specialized treatment for Alzheimer’s disease and other memory disorders, or receive treatment later in the progression of memory loss compared to their white and economically advantaged counterparts, a new study suggests.
What You Need To Know
- Black and poorer Americans are less likely to receive specialized treatment for Alzheimer’s disease and other memory disorders or receive treatment later in the progression of memory loss compared to their white and economically advantaged counterparts, a new study suggests
- The Centers for Disease Control and Prevention estimates roughly 14% of Black Americans ages 65 and older have Alzheimer’s disease or related dementias
- In the next forty years, the CDC expects the number of cases among Black Americans will increase fourfold and Latinos will see seven times as many cases as they had in 2014
- On their first visit to the clinic examined in the study, 40% of Black patients had mild dementia or worse, compared to 31% of white patients. And 16% of Black patients had moderate to severe dementia while only 10% white patients were diagnosed with the same conditions
- A specific protein — beta amyloid — that scientists believe is a precursor to Alzheimer’s are more likely to be found in white patients than Black patients. Studies have suggested Black Americans’ dementia can be connected to other health conditions — including vascular disease, major depressive disorder and diabetes, the Washington University researchers wrote
- Because of the history of structural racism and barriers to health care — specifically in the St. Louis region — the study’s authors wrote the results were unsurprising. In part, Black patients may be discouraged from receiving treatment because of historical skepticism of a health care system that has denied them coverage or provided inadequate care
“Many older adults have concerns about their memory and thinking,” the researchers from Washington University in St. Louis wrote in a study published last week. “An evaluation by a memory specialist can help diagnose the etiology [causes] of cognitive impairment, guide treatment, and lead to referrals for resources.”
However, disparities in health care and insurance access as well as the dearth of specialized memory clinics in the United States “suggest that patients with a lower socioeconomic status and who identify as Black are less likely to be seen in memory clinics, which are likely to be a major point of access for any new Alzheimer disease treatments that may become available,” according to a summary of the study published in the journal Neurology, which bills itself as “the most widely read and highly cited peer-reviewed neurology journal.”
The Centers for Disease Control and Prevention estimates roughly 14% of Black Americans ages 65 and older have Alzheimer’s disease or related dementias. In the next forty years, the CDC expects the number of cases among Black Americans will increase fourfold and Latinos will see seven times as many cases as they had in 2014.
The WashU researchers examined health record data from their institution’s Memory Diagnostic Center, focusing on what neighborhoods patients resided in and whether they identified as Black or white. In all, they studied the profiles of 4,824 patients between 2008 and 2018. Only 11% were Black, despite census data showing 16% of the local population were Black.
Other racial groups were not included in the study because of statistically small sample sizes of those populations. Another limitation of the study, the researchers wrote, was that it only studied the single memory clinic, albeit the largest one in the region.
“Black patients lived in less advantaged neighborhoods, and Black patients were more likely than White patients to have moderate or severe dementia at their initial visit,” according to the study.
On their first visit to the clinic, 40% of Black patients had mild dementia or worse, compared to 31% of white patients. And 16% of Black patients had moderate to severe dementia while only 10% white patients were diagnosed with the same conditions.
The result may mean Black patients and others living in less affluent areas will have inadequate access to new treatments.
“If more effective [Alzheimer’s disease] treatments become available, it seems likely that underserved groups, such as patients living in less affluent areas as well as minoritized groups, would have reduced access because they may be less likely to be seen in memory clinics that will serve as a major access point for these treatments,” the researchers concluded.
And because treatments will likely be more effective earlier in the progression of memory loss, the delay in Black patients seeking or receiving care could be “less likely to be eligible for new [Alzheimer’s] treatments at the time of their initial clinic visit,” according to the study.
“Delays in diagnosis may further worsen if demand for memory care substantially increases, as may occur if an effective treatment becomes widely available,” the study’s authors wrote. “Disparities may be further exacerbated if there is increased demand for memory care by more advantaged groups, which may strain already limited resources and further delay care to disadvantaged groups.”
That disparity could be found in recent studies that examined two drugs the medical community see as a legitimate hope to stem the progression of Alzheimer’s. In the clinical trial for Leqembi, a drug that received full approval from U.S. regulators in July, 49% of Black participants were screened out and made up only 4.5% of the trial. Black Americans make up 13.7% of the U.S. population.
Leqembi will cost $26,500 a year and while Medicare will cover much of that price, enrollees will still have to pay more than $5,000 a year, according to health policy nonprofit KFF. Half of Medicare beneficiaries have less than $30,000 in income, KFF estimated in 2020. A quarter made less than $17,000.
“Today’s action is the first verification that a drug targeting the underlying disease process of Alzheimer’s disease has shown clinical benefit in this devastating disease,” said Teresa Buracchio, the acting director of the Food and Drug Administration’s Office of Neuroscience, on July 6. “This confirmatory study verified that it is a safe and effective treatment for patients with Alzheimer’s disease.”
A specific protein — beta amyloid — that scientists believe is a precursor to Alzheimer’s are more likely to be found in white patients than Black patients. Studies have suggested Black Americans’ dementia can be connected to other health conditions, including vascular disease, major depressive disorder and diabetes, the Washington University researchers wrote.
Because of the history of structural racism and barriers to health care — specifically in the St. Louis region — the study’s authors wrote the results were unsurprising. In part, Black patients may be discouraged from receiving treatment because of historical skepticism of a health care system that has denied them coverage or provided inadequate care.
There are no Black clinicians at Washington Unviersity’s Memory Diagnostic Center.
“The St. Louis region, like many other metropolitan areas, also has a history of redlining, which can worsen health disparities,” they wrote. “Like many major cities, the areas most populated by the Black community have fewer health care facilities and lack adequate public transportation.”
Ultimately, one co-author of the study said, it is vital the memory care industry gets to Black and economically disadvantaged groups earlier to help them live longer, better lives.
“Dementia care is going through a major transformation right now,” said co-author Dr. Suzanne Schindler, a neurology professor, in a release. “With these new therapeutics, getting evaluated at a specialty clinic early on — when symptoms first develop — is going to be important in a way that it never was before.”