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

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. 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. 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. 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. 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. 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. 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. 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. 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. WISCONSIN ALZHEIMER’S INSTITUTE
What is Alzheimer’s?

11. WISCONSIN ALZHEIMER’S INSTITUTE
What is Alzheimer’s?

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. WISCONSIN ALZHEIMER’S INSTITUTE
Alzheimer’s, Millions
No. of Persons with
Projected Prevalence of Alzheimer’s
Hebert et al., Arch Neurol 2003.

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. WISCONSIN ALZHEIMER’S INSTITUTE
Gender and Dementia

25. WISCONSIN ALZHEIMER’S INSTITUTE
AD Risk Age and Sex

26. WISCONSIN ALZHEIMER’S INSTITUTE
Alzheimer’s & Women: Impact of Caregiving