Types of Dementia, African Americans and Dementia

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Gina Green-Harris, University of Wisconsin Alzheimer's Institute

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Types of Dementia, African Americans and Dementia

  1. 1. WISCONSIN ALZHEIMER’S INSTITUTE Types of Dementia African Americans and Dementia Gina Green-Harris UW-Wisconsin Alzheimer’s Institute Wisconsin Women’s Health Foundation October 10-11, 2013
  2. 2. WISCONSIN ALZHEIMER’S INSTITUTE 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 4
  3. 3. WISCONSIN ALZHEIMER’S INSTITUTE Types of Dementia 5% 5% 8% Alzheimer's Disease (AD): 65% AD & Vascular: 10% 7% 10% Lewy body: 7% 65% AD and Lewy body: 5% Vascular: 5% Other: 8% Adapted from figure on www.alz.org 14
  4. 4. WISCONSIN ALZHEIMER’S INSTITUTE What is Alzheimer’s? Most common type of Dementia Slow, insidious onset Progressive decline Characteristic Cognitive Changes Memory Language Executive function Personality changes Other dementias considered & ruled out
  5. 5. WISCONSIN ALZHEIMER’S INSTITUTE 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
  6. 6. WISCONSIN ALZHEIMER’S INSTITUTE Vascular Dementia Impaired 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.
  7. 7. WISCONSIN ALZHEIMER’S INSTITUTE Course of the Disease “Mild Cognitive Impairment” “Pre-Alzheimer’s Disease” Better Normal Dementia d oa ic L log tho Moderate a P Worse Cognition Mild Severe time
  8. 8. WISCONSIN ALZHEIMER’S INSTITUTE What is Alzheimer’s? In the brain: Senile Beta-Amyloid plaques Neurofibrillary tangles cause Atrophy (tissue shrinks due to cell death) Loss of synapses (connections between brain cells) Inflammation
  9. 9. WISCONSIN ALZHEIMER’S INSTITUTE Dr. Alzheimer first to describe tangles. “We must not be satisfied to force it into the existing group of well known disease patterns.”
  10. 10. WISCONSIN ALZHEIMER’S INSTITUTE What is Alzheimer’s?
  11. 11. WISCONSIN ALZHEIMER’S INSTITUTE What is Alzheimer’s?
  12. 12. WISCONSIN ALZHEIMER’S INSTITUTE Prevalence, % 1 00 Alzheimer’s is Common 80 60 40 20 0 6 5- 74 75 - 8 4 Age, years 85 + Evans et al., JAMA 1989.
  13. 13. WISCONSIN ALZHEIMER’S INSTITUTE Alzheimer’s, Millions No. of Persons with Projected Prevalence of Alzheimer’s Hebert et al., Arch Neurol 2003.
  14. 14. WISCONSIN ALZHEIMER’S INSTITUTE 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. http://www.alz.org/national/documents/report_afr
  15. 15. WISCONSIN ALZHEIMER’S INSTITUTE 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
  16. 16. WISCONSIN ALZHEIMER’S INSTITUTE Barriers to Early Identification in 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
  17. 17. WISCONSIN ALZHEIMER’S INSTITUTE 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
  18. 18. WISCONSIN ALZHEIMER’S INSTITUTE 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. http://www.alz.org/national/documents/repor t_africanamericanssilentepidemic.pdf
  19. 19. WISCONSIN ALZHEIMER’S INSTITUTE 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.
  20. 20. WISCONSIN ALZHEIMER’S INSTITUTE African Americans and Dementia Barriers African-Americans tend to be diagnosed at a later stage of Alzheimer’s disease — limiting the effectiveness of treatments that depend upon early intervention. http://www.alz.org/national/documents/repor t_africanamericanssilentepidemic.pdf
  21. 21. WISCONSIN ALZHEIMER’S INSTITUTE African Americans and Dementia Barriers African-Americans are seriously underrepresented in current clinical trials of potential treatments for Alzheimer’s disease http://www.alz.org/national/documents/repor t_africanamericanssilentepidemic.pdf
  22. 22. WISCONSIN ALZHEIMER’S INSTITUTE 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/repor t_africanamericanssilentepidemic.pdf
  23. 23. WISCONSIN ALZHEIMER’S INSTITUTE Alzheimer’s and Women Majority of Alzheimer’s patients are women Caregivers more likely to be women 75% of caregivers for people with AD are women 50% spouse (64% wives) 40% children (~68-76% daughters and daughter-in-laws)
  24. 24. WISCONSIN ALZHEIMER’S INSTITUTE Gender and Dementia
  25. 25. WISCONSIN ALZHEIMER’S INSTITUTE AD Risk Age and Sex
  26. 26. WISCONSIN ALZHEIMER’S INSTITUTE Alzheimer’s & Women: Impact of Caregiving

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