Padideh Kamali-Zare, Ph.D.

Cognitive Future

Racial Disparities, African Americans, and Alzheimer's Disease

On grey matters our research should be inclusive, encouraging participation.

Posted Jun 17, 2020

NIH - National Institute on Aging
The NIA profiled Keretha, above, because she wanted to set an example for increased participation in Alzheimer's research.
Source: NIH - National Institute on Aging

African Americans are afflicted with Alzheimer’s disease at higher rates than Whites, according to a variety of scientific studies and reviews mentioned in the 2020 report of the Alzheimer’s Association. Adjustment for comorbidities and healthcare utilization does not substantially explain differences in dementia incidence. Long before COVID-19, from 1999 to 2014, their Alzheimer’s deaths increased 99 percent when it only increased 55 percent among all Americans.

“Alzheimer’s isn’t an equal opportunity disease,” writes Karen Lincoln, a Senior Scientist at USC’s Roybal Institute on Aging and Director of its Hartford Center of Excellence in Geriatric Social Work.

Life, the essence of being, growing, and impacting, has no color, yet it presents itself in all colors and forms. Under our skin, though, we are the same color; our cells and blood are made of the same particles.

Our brain tissue is made of the same material: brain cells (neurons and glial cells) and the gap between them (extracellular space). That space in-between — Darmiyan in Persian — has the same geometry and content (extracellular matrix), and the matrix has the same molecules and atoms no matter what our skin color or genetic profile is. So what is it that makes our life and death, and more importantly our health and disease patterns, so different? 

One answer lies in what challenges we face in life and the toll it takes on the brain to constantly overcome those challenges. The most immediate environment in which our brain is born and developed, and later interacts with during our adult life, makes all the difference. It impacts how we view the world and react to it, and affects our brain health tremendously. If that environment is full of injustice, discrimination, and racism, our brain experiences huge amounts of stress that dramatically decrease its healthy function.

Research Findings

Countless studies have experimentally demonstrated the negative impact of stress on health, especially on the progression of diseases from cancer to cardiovascular disease and neurodegenerative diseases. Stress increases Alzheimer’s-disease-related pathology in a wide variety of experimental contexts. Exposure to stress is shown to increase the expression of amyloid precursor protein (APP) and the generation of Aβ peptide, a gene and peptide which contribute to  AD pathophysiology (see Justice 2018). Metanalyses find an adverse impact between racial discrimination and mental health.

Vanderbilt University’s Renã A.S. Robinson notes that African Americans are twice as likely to suffer from Alzheimer’s Disease than Whites, but that they represent fewer than 5 percent of drug trial participants even though they comprise about 13 percent of the U.S. population.

Robinson says, "This makes it hard to know if and how these potential therapies may work for Blacks and other underrepresented groups.” She became interested in degenerative disease when she was a young girl in Louisville and her mother cared for people with dementia. Now a leader in diversity in STEM at Vanderbilt, Robinson is studying the role the heart, liver, and kidneys play in Alzheimer’s, and exploring how a gene involved in lipid transport increases risk for Alzheimer’s disease.

Personal Commitments

We must ensure that African Americans do not face racial discrimination in society or within the healthcare system and must commend institutions like the National Institutes of Health supporting research on disparities in the health outcomes of African Americans.

When memory loss strips away a person’s independence, it can undermine their ability to take proper care of themselves, ward off fraud, and manage a healthy aging process, leding to painful economic burdens on their family members. These are just a few reasons why it’s important to develop a standard of care that objectively checks up on each person’s aging brain.

I stand with UsAgainstAlzheimer's in quoting the late Dr. Martin Luther King Jr.: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

We must commit to inclusion and equality in our basic science studies, translational research, technology innovations, and clinical trials. That will not only further our understanding of the disease; it will help us bring advances to all people. So as we work daily to create a whole solution for Alzheimer’s, we invite all people of all races to walk with us on the trail to a cure.

References

Alzheimer's Facts and Figures Report. (Alzheimer's Association, 2020) https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf

Begley, S. (2020, June 15). To grasp who’s dying of Covid-19, look to social factors like race. STAT. https://www.statnews.com/2020/06/15/whos-dying-of-covid19-look-to-social-factors-like-race/

Carter, R. T., Lau, M. Y., Johnson, V., & Kirkinis, K. (2017). Racial Discrimination and Health Outcomes Among Racial/Ethnic Minorities: A Meta-Analytic Review. Journal of Multicultural Counseling and Development, 45(4), 232–259. https://doi.org/10.1002/jmcd.12076

Hamilton, J. (2019, December 17). Scientists Reach Out To Minority Communities To Diversify Alzheimer’s Studies. NPR Shots; NPR. https://www.npr.org/sections/health-shots/2019/12/17/787772971/scientists-reach-out-to-minority-communities-to-diversify-alzheimers-studies

Justice, N. J. (2018). The relationship between stress and Alzheimer’s disease. Neurobiology of Stress, 8, 127–133. https://doi.org/10.1016/j.ynstr.2018.04.002

Lincoln, K. (2019, February 28) First Opinion: HHS must act boldly to help African-Americans fight Alzheimer’s disease. https://www.statnews.com/2019/02/28/alzheimers-disease-african-americans

Lincoln, K. (2018, September 21). African Americans Suffer From Alzheimer’s at High Rates. The Crisis; NAACP. https://www.thecrisismagazine.com/single-post/2018/09/21/African-Americans-Suffer-From-Alzheimer%E2%80%99s-at-High-Rates

Lincoln, K. D., Chow, T. W., & Gaines, B. F. (2019). BrainWorks: A Comparative Effectiveness Trial to Examine Alzheimer’s Disease Education for Community-Dwelling African Americans. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 27(1), 53–61. https://doi.org/10.1016/j.jagp.2018.09.010

Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., & Whitmer, R. A. (2016). Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer’s & Dementia: The Journal of the Alzheimer's Association, 12(3), 216–224. https://doi.org/10.1016/j.jalz.2015.12.007

Robinson, R. A. S. (2020, February 24). Black People Are At Higher Risk For Alzheimer’s, But Why? Moguldom. https://moguldom.com/259378/black-people-are-at-higher-risk-for-alzheimers-but-why/

Statement on the Death of George Floyd and the Social Justice Protests Across the Nation. (Jun3, 2020). UsAgainstAlzheimer’s.  https://www.usagainstalzheimers.org/press/usagainstalzheimers-statement-death-george-floyd-and-social-justice-protests-across-nation

USC Suzanne Dworak-Peck School of Social Work. (2018, November 5). How to Improve Alzheimer’s Education among African Americans (BrainWorks). YouTube. https://www.youtube.com/watch?v=7v0FGzIwhT4

Xu, J., Murphy, S. L., Kochanek, K. D., & Bastian, B. A. (2016). Deaths: Final Data for 2013. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 64(2), 1–119. https://www.ncbi.nlm.nih.gov/pubmed/26905861