Ethnoracial Differences in the Clinical Characteristics of Alzheimer's Disease at Initial Presentation at an Urban Alzheimer's Disease Center

From the Penn Memory Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 05/2011; 19(5):430-9. DOI: 10.1097/JGP.0b013e3181f7d881
Source: PubMed


To compare presentation of Alzheimer disease (AD) at the time of initial evaluation at a university specialty clinic across three ethnoracial groups in order to understand similarities and differences in the demographic, clinical, cognitive, psychiatric, and biologic features.
Cross-sectional study.
A total of 1,341 self-identified African American, Latino (primarily of Caribbean origin), and white non-Hispanic ("WNH") subjects were recruited from primary care sites or by referral by primary care physicians.
Demographic variables and age of onset of AD, as well as cognitive, functional, and mood impairments at the time of initial presentation and frequencies of apolipoprotein E genotypes, were compared across groups.
Differences among ethnoracial groups were found for nearly all variables of interest. In particular, the largely immigrant Puerto Rican Latino group had an earlier age of onset of AD, more cognitive impairment, and greater severity of cognitive impairment at the time of initial evaluation in the setting of low average education and socioeconomic status. There was more depression in the Latinos compared with African Americans and WNHs. Greater severity of symptoms was not accounted for by a difference in lag time between onset of symptoms and initial evaluation. The apolipoprotein E-4 genotype was not associated with AD in the Latino cohort.
Minority groups in Philadelphia, especially Latinos, exhibit a more severe profile of AD at the time of presentation than WNHs. Important potential confounds need to be considered and future research comparing immigrant and nonimmigrant Latino groups will be necessary to elucidate the highly significant differences reported.

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Available from: Irving E Vega, Oct 07, 2015
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    • "However, African-Americans are less likely to report cognitive and functional problems in older family members until the impairments become severe [41]. This highlights the need for culturally sensitive educational programs that emphasize the differences between normal and pathological cognitive aging, and the value of research focusing on the benefits to both the individual and the whole community now and in the future [45] [46]. Milestones addressing these concerns focus on providing a central resource on best practices for recruitment and retention, increasing awareness of and access to large scale Alzheimer's-related registries and cohorts, and increasing the enrollment of participants from underrepresented populations in clinical trials. "
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    ABSTRACT: With increasing numbers of people with Alzheimer's and other dementias across the globe, many countries have developed national plans to deal with the resulting challenges. In the United States, the National Alzheimer's Project Act, signed into law in 2011, required the creation of such a plan with annual updates thereafter. Pursuant to this, the US Department of Health and Human Services (HHS) released the National Plan to Address Alzheimer's Disease in 2012, including an ambitious research goal of preventing and effectively treating Alzheimer's disease by 2025. To guide investments, activities, and the measurement of progress toward achieving this 2025 goal, in its first annual plan update (2013) HHS also incorporated into the plan a set of short, medium and long-term milestones. HHS further committed to updating these milestones on an ongoing basis to account for progress and setbacks, and emerging opportunities and obstacles. To assist HHS as it updates these milestones, the Alzheimer's Association convened a National Plan Milestone Workgroup consisting of scientific experts representing all areas of Alzheimer's and dementia research. The workgroup evaluated each milestone and made recommendations to ensure that they collectively constitute an adequate work plan for reaching the goal of preventing and effectively treating Alzheimer's by 2025. This report presents these Workgroup recommendations.
    Alzheimer's & dementia: the journal of the Alzheimer's Association 10/2014; 10(5 Suppl):S430-52. DOI:10.1016/j.jalz.2014.08.103 · 12.41 Impact Factor
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    • "Although the difference in APOE ε4 allele frequency between the two groups did not reach statistical significance, possibly as a result of the relatively small number of cases for which APOE results were available, the APOE ε4 allele was less common in Hispanics than in non- Hispanics, suggesting that other genetic or possibly reversible environmental dementia risk factors may contribute to a greater extent in the Hispanic population than in their non-Hispanic White counterparts. Multiple studies (Gurland et al., 1999; Tang et al., 2001; Clark et al., 2005; Livney et al., 2011) using varied methodologies have suggested that Hispanics from both eastern and western US regions may be at greater risk for developing dementia at an earlier age than White non-Hispanics. Gurland et al., (Gurland et al., 1999) in a study comparing three ethno-racial groups consisting of East Coast Hispanics, African Americans, and White non-Hispanics, found Hispanics to have the greater prevalence rates of dementia in every stratified age group. "
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    ABSTRACT: Prior studies of US Hispanics, largely performed on the East Coast, have found a younger age of dementia onset than in White non-Hispanics. We performed a cross-sectional study to examine clinical and sociodemographic variables associated with age of dementia diagnosis in older Hispanics and White, non-Hispanics in southern California. Two hundred ninety (110 Hispanic and 180 White non-Hispanic) community dwelling, cognitively symptomatic subjects, aged 50 years and older, were assessed and diagnosed with probable Alzheimer's disease or probable vascular dementia. Apolipoprotein E (APOE) genotype was assessed in a subset of cases. Analysis of variance and multiple stepwise linear regression were used to assess main effects and interactions of ethnicity with dementia severity (indexed by mini mental state examination scores) and other sociodemographic and clinical variables on age of dementia diagnosis. Hispanics were younger by an average of 4 years at the time of diagnosis, regardless of dementia subtype, despite a similar prevalence of the APOE ϵ4 genotype. The earlier age at diagnosis for Hispanics was not explained by gender, dementia severity, years of education, history of hypercholesterolemia, hypertension, or diabetes. Only ethnicity was significantly associated with age of onset. These findings confirm that US Hispanics living in the southwestern USA tend to be younger at the time of dementia diagnosis than their White non-Hispanic counterparts. As this is not explained by the presence of the APOE ϵ4 genotype, further studies should explore other cultural, medical, or genetic risk factors influencing the age of dementia onset in this population. Copyright © 2014 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 06/2014; 29(6). DOI:10.1002/gps.4040 · 2.87 Impact Factor
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    • "We previously reported a younger age of onset of dementia in Hispanics compared with other ethnoracial groups. While this single mutation may explain some of this observation, we note that the mean age of onset of 69.0 in our non-carrier Hispanic subjects with AD is still younger than white non-Hispanics (mean 72.4) or African Americans (73.5) [2]. While the PSEN1 Gly206Ala mutation's origin is not known, all cases derive from a common founder and have Puerto Rican heritage. "
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    ABSTRACT: The frequency and clinical and pathological characteristics associated with the Gly206Ala presenilin 1 (PSEN1) mutation in Puerto Rican and non-Puerto Rican Hispanics were evaluated at the University of Pennsylvania's Alzheimer's Disease Center. DNAs from all cohort subjects were genotyped for the Gly206Ala PSEN1 mutation. Carriers and non-carriers with neurodegenerative disease dementias were compared for demographic, clinical, psychometric, and biomarker variables. Nineteen (12.6%) of 151 unrelated subjects with dementia were discovered to carry the PSEN1 Gly206Ala mutation. Microsatellite marker genotyping determined a common ancestral haplotype for all carriers. Carriers were all of Puerto Rican heritage with significantly younger age of onset, but otherwise were clinically and neuropsychologically comparable to those of non-carriers with AD. Three subjects had extensive topographic and biochemical biomarker assessments that were also typical of non-carriers with AD. Neuropathological examination in one subject revealed severe, widespread plaque and tangle pathology without other meaningful disease lesions. The PSEN1 Gly206Ala mutation is notably frequent in unrelated Puerto Rican immigrants with dementia in Philadelphia. Considered together with the increased prevalence and mortality of AD reported in Puerto Rico, these high rates may reflect hereditary risk concentrated in the island which warrants further study.
    Journal of Alzheimer's disease: JAD 10/2012; 33(4). DOI:10.3233/JAD-2012-121570 · 4.15 Impact Factor
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