Alzheimer’s disease (which is the most common cause of dementia and memory loss amongst older adults) is devastating our aging population at an alarming rate, so much so that there’s been pressure amongst the medical community to declare it a national health crisis. An increasing body of evidence shows that African-Americans face a significantly higher risk for forms of dementia (including mixed dementia, vascular dementia and Alzheimer’s disease) compared to non-Hispanic white populations. In fact, while Alzheimer’s is the most common type of dementia amongst non-Hispanic white populations, we’ve seen a higher prevalence of mixed dementia (a combination of Alzheimer’s and vascular dementia) in the African-American population.
For some time, health conditions and genetic factors were thought to be the main risks for dementia, and the role that race plays in the disease was not considered. Now, research shows that the prevalence of Alzheimer’s disease is up to 300% higher in African-Americans. While environmental factors may be at play, there is a general consensus amongst the medical community that there is a greater familial risk of dementia and Alzheimer’s for this segment of the population and that, according to the Alzheimer’s Association, “genetic factors may work differently to cause Alzheimer’s disease in African-Americans.”
While genetics play a role, dementia amongst the African-American community is affected more by vascular factors. There is a much greater proportion of vascular dementia and mixed dementia in African-Americans. So, while genetics may play factor, the contribution of vascular health makes lifestyle especially relevant in the abatement and prevention of dementia in this segment of the population.
The increased risk amongst the African-American population causes significant physical, psychological, emotional and financial burdens to this group, many of whom are unaware of the risk. According to the Alzheimer’s Association, the situation is urgent, especially considering that “the epidemic of Alzheimer’s will continue to spread over the next 30 years, as the number of African-Americans entering the age of risk more than doubles to 6.9 million.”
Awareness of the increased risk of dementia to the African-American community and education about life choices that can reduce the risk of developing the disease are critical steps towards prevention.
Why the Increased Risk?
There are several conditions that have a higher association with dementia, mixed dementia and Alzheimer’s disease, like:
- Cardiovascular disease
- Stroke
- Chronic kidney disease
- Diabetes
- High cholesterol
- High blood pressure
- Stress
- Low educational state
It’s generally believed that these conditions, which have a higher prevalence in the African-American community, contribute to the increased rates of dementia, mixed dementia and Alzheimer’s that exist in African-Americans compared to non-Hispanic whites. Of these conditions, the most striking are vascular diseases.
Vascular factors
Vascular factors, which are medical conditions that impact the blood vessels may trigger dementia and Alzheimer’s. Vascular risk factors like cardiovascular disease, stroke, diabetes, high cholesterol and high blood pressure are known to be disproportionately present amongst those in the African-American community.
While these risk factors are often treatable on their own, there is no cure for Alzheimer’s once it fully manifests. In other words, if the risk factors are not treated, patients are likely to develop Alzheimer’s mixed dementia, and vascular dementia. However, new observational research shows that drugs that treat vascular diseases may also protect against cognitive impairment and Alzheimer’s disease. As Dr. James M. Ellison, MD, MPH of the Swank Memory Care center argues that “mid-life recognition and treatment of vascular risk factors may be important tools in reducing AD risk.” We started the Healthy Minds Initiative, to support individuals and communities in reducing their risk of dementia through early prevention. Changes in lifestyle (like following an anti-inflammatory diet) can prevent dementia, and Healthy Minds Initiative is committed to providing the knowledge, structure, funding and resources needed to help communities combat cognitive diseases like dementia through preventative measures.
Sociocultural factors
Dr. Ellison states that there is evidence that shows that “the likelihood of developing AD is inversely related to educational achievement and income.” Although African-Americans continue to overcome these environmental barriers, income and education may play a role in contributing to the community’s increased risk of developing Alzheimer’s, especially with regards to health care inequalities.
Unequal access to health care
Unfortunately, there is inequality regarding diagnostic testing, access to medical specialists and preventative care. While the reasons are numerous and complex, they include socioeconomic factors as well as geography and population density. There is no doubt that this inequality is a very real barrier in the recognition and treatment of Alzheimer’s disease, one that must be addressed immediately.
How to Reduce the Risk
A significant body of evidence has proven that adopting a brain-healthy lifestyle can slow down and, in some cases, even prevent the development of Alzheimer’s disease. We believe a lifestyle-focused preventative approach is the solution we need. While there is a known link between a high body-mass index and the development of Alzheimer’s disease, a healthy weight alone is not enough to reduce the risk of the disease. Prevention requires taking a wholistic approach to brain-health.
Brain Initiative’s NEURO Academy provides education, community support, direct engagement, meal plans and exercises to support people in adopting a brain-healthy lifestyle. Nutrition, Exercise, Restorative Sleep, Unwinding, and Optimization (or N.E.U.R.O.) are five pivotal factors that can drastically affect brain-health.
- Nutrition has been linked to as much as a 53% potential reduction in Alzheimer’s
- Exercise has been shown to reduce the risk of developing Alzheimer’s by as much as 40%
- Stress management (unwinding) helps avoid shrinkage of the brain by 30%
- Restoring proper sleep in the context of chronic sleep disorder can reduce dementia risk by 70%
- Mental and social activity (optimization) reduces Alzheimer’s risk by 48%
We believe it’s important that the African-American community and the healthcare community work together to advocate for culturally appropriate services that are affordable and accessible. These services should include preventative strategies, education, assessment, diagnosis, financial support and care.
We will continue to remain strong advocates for more research into the risks, treatment, and prevention of Alzheimer’s disease in the African-American community, as well as other at-risk populations.
Related Links: https://www.alz.org/media/Documents/african-americans-silent-epidemic-r.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/
https://www.brightfocus.org/alzheimers/article/burden-alzheimers-disease-african-americans
https://www.statnews.com/2019/02/28/alzheimers-disease-african-americans/
https://www.usatoday.com/story/news/2019/01/28/african-americans-face-greater-risk-alzheimer s-disease-than-whites/2702501002/
