Types of DementiaAfrican Americans and Dementia

Gina Green-HarrisUW-Wisconsin Alzheimer’s Institute

Wisconsin Women’s Health FoundationOctober 10-11, 2013

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What is Dementia?• A decline in cognitive

ability that involves Memory loss

• Changes in other mental skills (e.g., reasoning, perception, language)

• Changes in personality• Severe enough to

interfere with daily life or social interactions

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4

Types of Dementia

65%10%

7%

5%

5%8% Alzheimer's Disease (AD): 65%

AD & Vascular: 10%

Lewy body: 7%

AD and Lewy body: 5%

Vascular: 5%

Other: 8%

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14Adapted from figure on www.alz.org

Most common type of DementiaSlow, insidious onsetProgressive declineCharacteristic Cognitive Changes

MemoryLanguageExecutive function

Personality changesOther dementias considered & ruled out

What is Alzheimer’s?

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Dementia with Lewy Bodies

Symptoms of dementia with Lewy bodies include:•Memory loss•Movement symptoms•Hallucinations•REM sleep disorder•Disruption of the autonomic nervous system

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Vascular DementiaImpaired judgment or ability to plan steps needed to complete a task is more likely to be the initial symptom.Brain injuries such as microscopic bleeding and blood vessel blockage. The location of the brain injury determines how the individual's thinking and physical functioning are affected.

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Normal

Dementia

Mild

Moderate

Severe

Cog

nit

ion

Wors

e

Bett

er

time

Course of the Disease“Pre-Alzheimer’s Disease”

“Mild Cognitive Impairment”

Pathologic

Pathologic

LoadLoad

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In the brain:Senile Beta-Amyloid plaquesNeurofibrillary tangles

cause

Atrophy (tissue shrinks due to cell death)Loss of synapses (connections between

brain cells)Inflammation

What is Alzheimer’s?

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Dr. Alzheimer first to describe tangles. “We must not be satisfied to force it into the existing group of well known disease patterns.”

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What is Alzheimer’s?

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What is Alzheimer’s?WISCONSIN ALZHEIMER’S INSTITUTE

Alzheimer’s is Common

0

20

40

60

80

100

65-74 75-84 85+

Age, years

Pre

vale

nce

, %

Evans et al., JAMA 1989.

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Projected Prevalence of Alzheimer’s

No.

of

Pers

on

s w

ith

Alz

heim

er’

s, M

illio

ns

Hebert et al., Arch Neurol 2003.

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African Americans and Dementia

• Alzheimer’s disease is more prevalent among African-Americans than among whites — with estimates ranging from 14% to almost 100% higher

• There is a greater familial risk of Alzheimer’s in African-Americans; and

• Genetic and environmental factors may work differently to cause Alzheimer’s disease African

Americans.

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http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

African Americans and Dementia • Sixty-five percent of African-American Medicare

beneficiaries have hypertension

• African Americans are also at higher risk of stroke.

• African-Americans have a 60% higher risk of type 2 diabetes

• African-Americans have a higher rate of vascular

dementia than white Americans. http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

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Barriers to Early Identificationin African Americans

• Multiple factors contribute– Lack of access to knowledgeable health

care providers– Response of providers to patient/family

concerns or complaints– Perceived stigma and social

consequences of diagnosis– Lack of family support – Belief that there are no effective

treatments

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Risk Factors

Things I can Change• Weight• Health Conditions

– Heart Disease– High Blood Pressure– Diabetes– Stroke

• Stress• Diet• Exercise• Education

Things I cannot Change

• Age• Race/Ethnicity• Genetics ( APOE, TOMM 40)• Family History

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African Americans and Risk

Vascular disease may be a particularly powerful factor in the prevalence of Alzheimer’s among African Americans.Persons with a history of either high blood pressure or high cholesterol levels are twice as likely to get Alzheimer’s disease. Those with both risk factors are four times as likely to become demented.

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http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

The APOE- 4 Allele and the Risk of Alzheimer ∊Disease Among African Americans, Whites, and

Hispanics

The presence of an APOE- 4 allele is a ∊determinant of AD risk in whites, but African Americans and Hispanics have an increased frequency of AD regardless of their APOE genotype. These results suggest that other genes or risk factors may contribute to the increased risk of AD in African Americans and Hispanics.

JAMA. 1998;279(10):751-755. doi:10.1001/jama.279.10.751.

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African Americans and DementiaBarriers

African-Americans tend to be diagnosed at a later stage of Alzheimer’s disease — limiting theeffectiveness of treatments that depend uponearly intervention.

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http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

African Americans and DementiaBarriers

African-Americans are seriously underrepresented in current clinical trials of potential treatments for Alzheimer’s disease

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http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

African Americans and Dementia

African-Americans who are evaluated have a much higher rate of false-positive results. At the same time, there is substantial evidence of underreporting of dementia among African Americans.

http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

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Majority of Alzheimer’s patients are womenCaregivers more likely to be women

75% of caregivers for people with AD are women50% spouse (64% wives)40% children (~68-76% daughters

and daughter-in-laws)

Alzheimer’s and Women

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Gender and Dementia

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AD Risk Age and Sex

Alzheimer’s & Women: Impact of CaregivingWISCONSIN ALZHEIMER’S INSTITUTE