Diabetes Modifies the Effect of Alzheimer Disease-Related Dementia Mortality Among Black Americans
In this podcast, Sri Banerjee, MD, PhD, MPH, MAS, discusses the impact of diabetes on Alzheimer disease-related dementia mortality among Black Americans, including the burden and pathophysiology of Alzheimer disease.
Additional Resources:
- Banerjee, S. Among African Americans diabetes modifies the effect of Alzheimer's disease-related dementia mortality. J Neurol Sci. 2023;455(suppl). doi:10.1016/j.jns.2023.121918
- Data shows racial disparities in Alzheimer’s disease diagnosis between Black and white research study participants. National Institute on Aging. December 16, 2021. Accessed February 13, 2024. https://www.nia.nih.gov/news/data-shows-racial-disparities-alzheimers-disease-diagnosis-between-black-and-white-research
TRANSCRIPTION:
Jessica Bard: Hello everyone, and welcome to another installment of Podcast360, your go-to resource for medical education and clinical updates. I'm your moderator, Jessica Bard with Consultant360, a multidisciplinary medical information network.
According to the National Institute on Aging, Black Americans are 35% less likely to be diagnosed with Alzheimer disease and related dementias compared with White Americans, despite national statistics that indicate people who are Black are twice as likely to develop dementias compared with people who are White. Black Americans also have higher rates of potential risk factors for Alzheimer disease, including hypertension and diabetes. Dr Sri Banerjee is here to speak with us today about his research titled “Among African Americans Diabetes Modifies the Effect of Alzheimer’s Disease Related Dementia Mortality.”
Dr Sri Banerjee: I'm Dr Sri Banerjee, core faculty for the College of Health Sciences and Public Policy at Walden University. I have almost 20 years of experience in public health.
Jessica Bard: Great. Well, thank you again for joining us on the podcast. Today we're talking about Alzheimer disease. What is the burden of Alzheimer disease in the United States?
Dr Banerjee: That's a great question, Jessica. As it turns out, 1/8 older Americans, 65 years or older are affected by Alzheimer disease-related dementia at an annual cost of more than $200 billion. With the future population increasing in the older age groups, estimates indicate that 13.5 million individuals in the US will have Alzheimer disease by the year 2050. Although race-based norms are helpful for increasing diagnostic accuracy in clinical settings, this makes a number of assumptions about biological constructs of race that might lead to erroneous and potentially harmful interpretations of underlying racial differences.
Jessica Bard: We're talking about your study here. Please provide us with an overview of your study “Among African Americans Diabetes Modifies the Effect of Alzheimer’s Disease-Related Dementia Mortality.”
Dr Banerjee: What I was looking for here is to understand compared with White Americans, how Black Americans longitudinally lead to Alzheimer disease-related mortality. And then I was trying to observe if diabetes actually enhances the effect of ethnicity in determining Alzheimer disease-related mortality? The findings speak for themselves.
Jessica Bard: Right. And we'll get into those findings, but before we do, what were the objectives of this study?
Dr Banerjee: That's a great question. Understanding the pathophysiology, that was one area that needed to be explored and then applying some of these findings in the context of racial disparities and then some of the conclusions that arise from these.
Jessica Bard: And we'll also get into some of those racial disparities. So, could you tell us more about the technique that you used to gather the information on these participants?
Dr Banerjee: Certainly. I looked at the National Health and Nutrition Examination Survey between the years 1999 and 2010, and the follow-up was through December 31st, 2019. So, the endpoint here was Alzheimer disease-related deaths, and the initial variable was ethnicity and then how diabetes modifies the effect.
Jessica Bard: What were the findings of this study?
Dr Banerjee: Great question. So here, some of the findings were that Alzheimer disease in African Americans is higher than in White Americans. Not only that, diabetes increased the impact of ethnicity on Alzheimer disease related deaths. So, the combination of diabetes and ethnicity were higher than just ethnicity alone. When you consider that as a variable.
Jessica Bard: Can you elaborate more on the racial disparities in Alzheimer disease?
Dr Banerjee: Certainly. Among Black Americans aged 70 or older, 21.3% are living with Alzheimer disease. Black Americans are twice as likely as older White Americans to have Alzheimer disease. Only 20% of Black Americans say they have no barriers to optimal healthcare and support for Alzheimer disease. And 55% of Black Americans think that significant loss of cognitive abilities or memory is a natural part of aging. Therefore, they would not go to a healthcare professional if they believed that memory loss is normal.
Jessica Bard: Can you tell us more about the pathophysiology of Alzheimer disease?
Dr Banerjee: Certainly, I’ll go over the pathophysiology and then also the disparities that are present between African Americans and White Americans. So, growing recognition is that Alzheimer disease and Alzheimer disease-related deaths pose significantly higher burden on caregivers… Alzheimer disease caregivers. There is a historical legacy of racial inferiority and systemic racism that has had a disastrous impact on how African Americans receive healthcare and interact with healthcare staff, particularly with the COVID-19 pandemic. Here, in addition, apolipoprotein E (apo-E) is a pathophysiologic indication of Alzheimer disease, and as it turns out, African Americans actually have more apolipoprotein E than other races.
Jessica Bard: What other conclusions can you draw from this study?
Dr Banerjee: So, some of the conclusions include ethnicity has an important role in Alzheimer disease-related mortality. More importantly, African American individuals with diabetes have an 84% higher likelihood associated with Alzheimer disease-related mortality than White Americans with the same disease. And then preventative measures must incorporate ethnicity as a consideration. Additionally, in the context of the pathophysiological disparities, these are determinant of Alzheimer disease risk in White Americans, however, apolipoprotein E is actually found more in African Americans than White Americans.
Jessica Bard: And what would you say are the overall take-home messages from this study and from our conversation today?
Dr Banerjee: Well, the most important is that Black Americans are impacted by Alzheimer disease. And if you go into some of the clinical trials and look at the commercials that you see, mostly you'll see Alzheimer disease related to White Americans. However, greater awareness needs to be there in order to determine the direct impact of not only Alzheimer disease, but also how chronic diseases also play a role in enhancing the effect between ethnicity and overall mortality. Another area that needs more exploration is Black older adults, since they would not go to a healthcare professional for memory problems, more awareness needs to be included in certain racial/ethnic groups.
Jessica Bard: Dr. Banerjee, thank you so much for joining us on the podcast today.
Dr Banerjee: Thank you.
Jessica Bard: For more research on Alzheimer disease, visit Consultant360.com.