African American Health Disparities in Cognition and Dementia

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African American Health Disparities in Cognition
and Dementia

• Peter A. Lichtenberg, Ph.D., ABPP
• Director, Institute of Gerontology
• Professor of Psychology, Psychiatry and
  Behavioral Neurosciences
• Wayne State University
• 87 E. Ferry Street
• Detroit, MI 48202
• p.lichtenberg_at_wayne.edu

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Overview of Presentation

• Introducing dementia and Alzheimers Disease
• Reviewing Studies related to dementia prevalence
  in African Americans and Whites
• Exploring the role of education and education
  quality on memory and cognitive testing
• Examining multiple mechanisms affecting cognitive
  differences
• Examining intra-group differences

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Dementia

• Syndrome of acquired intellectual impairment
• Decreased Social/Occupational function
• Caused by brain dysfunction
• Not delirium.

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Epidemiology ofDementia

• Dementia
• 6 Severe dementia
• 10-15 Mild to Moderate
• Alzheimers disease
• Incidence 1-4 per year
• Prevalence 3 age 65-75 47 age 85

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Number of People with AD, by Age Group (in
millions)

• Year Age 65-74 Age 75-84 Age 85 Total
• 2000 0.3 2.4 1.8
  4.5
• 2010 0.3 2.4 2.4
  5.1
• 2020 0.3 2.6 2.8
  5.7
• 2030 0.5 3.8 3.5
  7.7
• 2040 0.4 5.0 5.6
  11.0
• 2050 0.4 4.8 8.0
  13.2
• Hebert et al., Arch Neurol (2003), 60, 1119

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Alois Alzheimer (1864-1915)

• Neurosyphillis
• Worked with Nissl, Kraepelin
• August D
• Delusions all the time
• Memory impairment constant
• (vs intermittent)

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Chance favors the prepared mind

• Autopsy of August D
• Pyramidal cells
• packed with filaments
• Amorphous extracellular
• blobs
• These pathologic criteria remain for definitive
  diagnosis of Alzheimers disease.

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Healthy Brain

• 1,371 g
• Sulci opposed
• Smooth contour

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Neuropathology of Alzheimers Disease

• 1, 083g
• Irregular contour
• Primary areas intact

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Stages of Alzheimers Disease Preclinical AD

• Cognitive loss is not always apparent
• Very Mild problems with
• Memory
• Speed of processing
• Confrontation naming
• General cognitive abilities intact.
• Neuropathology has begun

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Alzheimer DiseaseEarly Phase

• Memory Problems
• Repeated Questions
• Forgetfulness
• Apathy/Withdrawal
• Gradual Impairment in advanced living skills.

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Alzheimers DiseaseModerate to End of Life

• Profound Cognitive problems.
• Aphasia
• Agnosia
• Apraxia
• Gradual loss of basic self care abilities.

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• Dementia in Older African
• Americans vs. Whites
• South Florida, New York
• Studies
• 2. Low genetic influence-apoe
• 3. Functional decline
• 4. Education effects are large

High rates of dementia in blacks Appears to be a
national issue Lower rates found in Nigeria
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Two Issues in Dementia Disparities

• 1. What risk factors account for increased
  prevalence of dementia?
• 2. What are the disparities with regard to
  detecting memory decline in African American
  elders?

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Vascular Disease relates to increased risk for
dementia 2002 city of Detroit Needs Assessment
Percent With Condition
Purple African Americans over age 60 Blue-
Whites over age 60
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Other environmental and health risk factors

• Pollution
• Physical Activity and Obesity
• Access to medical services
• Poverty esp. not affording medications

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2 Disparity in Detection of Memory Decline

• Deficit model of cognitive testing
• Failure of normative data

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Deconstructing race Factors influencing rates of
dementia

• Education Quantity AND Quality
• New York and Detroit studies
• Urban African Americans score lower on cognitive
  testing despite equal years of education
• Factoring in Quality of education leads to more
  accurate assessment of memory and dementia

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Per-pupil expendituresc. 1935
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Length of School Term
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ETHNICITY, GRADE, AND READING LEVEL
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Published in 2001 The clinical neuropsychologist,
Vol. 15, 196-202
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Dementia accuracy was much better with the Fuld
due to Its lack of relationship to education
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Keeping the brain healthy in later life 1.
Education is lifelong
Michigans Surgeon General Dr. Wisdom educates
Detroit seniors about Healthy living
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Strong link found between Cognition and Disability
The continued cognitive health of these men is
Directly related to their continued physical
health
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Physical Activity and a Healthy Brain
The Fired-up EX couch potatoes demonstrate the
ease of Exercise. Its importance to good
cognitive health cannot be over-stated