Dementia in the Black community
Dementia is the general term for a group of diseases or conditions that cause impairment to a person’s thinking, memories, or decision-making. Research has shown that people in the Black community often face barriers to their care for dementia, including delays in diagnosis.
Alzheimer’s disease is the most common type of dementia. Around 60–80% of people with dementia have Alzheimer’s.
According to the Alzheimer’s Association, older Black Americans are twice as likely to have dementia than older white Americans.
This article looks at the statistics around Black, Indigenous, and People of Color (BIPOC) and dementia. It also looks at inequalities regarding healthcare and ways society and individuals may be able to overcome the health inequalities that lead to an increased chance of dementia.
According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s and other forms of dementia are increasing in prevalence. There may be almost 14 million Americans with these conditions by 2060. There will be four times as many African Americans with these conditions by 2060 than there are now.
According to a report from the Alzheimer’s Association, Alzheimer’s can affect anywhere from 14–100% more African Americans than white Americans.
The number of African Americans over 65 is likely to more than double by 2030, from 2.7 million people in 1997 to 6.9 million people. Alzheimer’s affects over 10% of people of all races over 65.
Inequalities regarding healthcare
Certain health conditions increase the risk of developing dementia, with the following risk factors being more prevalent in the Black community:
High blood pressure
High blood pressure is a key risk factor for developing dementia in later life, particularly vascular dementia.
In 2017–2018, the U.S. Department of Health and Human Services found that 57.2% of Black males had high blood pressure, compared with 50.2% in white males. Similarly, they found that 56.7% of Black females had high blood pressure, compared with just 43.6% of white females.
A 2020 study shows that the lifelong discrimination that Black people experience may lead to higher blood pressure.
Learn more about high blood pressure in African Americans here.
Stress and depression
The added stress that Black people face every day can lead to high blood pressure as well as mental health conditions such as depression.
A 2015 systematic review found that people who experienced racism had higher rates of depression, which can lead to an increased risk of dementia in later life.
This extra stress may have many causes among people in the Black community, including:
- everyday racism
- residential segregation
- additional socioeconomic barriers
Learn more about the effects of racism on mental health here.
According to a 2020 report in The Lancet, type 2 diabetes has strong links to an increased risk of dementia, including Alzheimer’s disease and cognitive decline.
The National Institutes of Health states that Black people are twice as likely as white people to develop type 2 diabetes.
Some people have linked these elevated numbers among Black people to a possible genetic cause. But researchers in a 2017 study took into account biological, environmental, psychosocial, socioeconomic, and behavioral factors among participants. They found that Black people and white people have a similar likelihood of developing diabetes.
Learn more about why African Americans have a higher risk for diabetes here.
Heart disease and stroke
According to the Alzheimer’s Society, a person who has had a stroke or has heart disease is twice as likely to develop vascular dementia.
In the United States, a Black person is around one and a half times more likely to have a stroke than a white person. Data from 2018 suggests Black Americans were 30% more likely than white Americans to die from heart disease.
But a raised risk of developing heart disease may due to factors such as high blood pressure or poor diet.
Poor diet can be the result of socioeconomic difficulties. Data from the 2019 census shows that 17.4% of African American families were living under the poverty line at that time. Just 5.5% of non-Hispanic white families were living in the same situation.
Socioeconomic difficulties may mean a person has limited access to fresh food and fewer opportunities to exercise.
A 2020 genome study has identified new DNA regions that are unique to African Americans with Alzheimer’s disease.
These new pathways could provide a clue as to why BIPOC are more likely to develop dementia, but scientists have called for more research to explore this further.
In the meantime, it is crucial to address the many social causes of the increased prevalence of dementia among the Black community.
Inequalities in healthcare can also increase the risk of doctors misdiagnosing or overlooking early dementia.
Socioeconomic factors may also make it harder for BIPOC to gain health insurance or easily access health appointments.
Many experts have also criticized cognitive tests for dementia as being unsuitable for historically marginalized groups, potentially leading to an incorrect diagnosis.
Researchers create cognitive tests from years of research on white people, and they do not adjust them to take account of educational disparity and discrimination in BIPOC communities.
Ways to overcome these inequalities
A 2019 report into ethnic and racial disparities within Alzheimer’s and related dementias made the following recommendations, among others:
- Target and recruit BIPOC into studies and clinical trials on dementia and train researchers and practitioners to identify and address gaps in current research.
- Consider unique life experiences, such as poverty, stigma, and conflict, to more fully understand whether they play a role in the development of dementia.
- Develop more sophisticated tools and models that are more specific to BIPOC groups.
- Change frontline medical and public health approaches so that healthcare professionals treat and assess BIPOC from a perspective that considers their specific risk, depending on ethnicity.
The Commonwealth Fund, which has committed to becoming an antiracist organization, has also called for wider changes to overcome more general health inequalities in the U.S., including:
- Improving how doctors help BIPOC with chronic conditions, such as high blood pressure, to control their symptoms. This strategy must address issues of trust between healthcare professionals and BIPOC.
- Being more transparent about racial disparities in the treatment of certain conditions by collating and publishing data.
- Understanding how structural racism affects how BIPOC, limited by socioeconomic factors, can engage with their treatment and healthcare professionals. For example, increased reliance on public transport may mean missed appointments. Also, having fewer supermarkets in the local area is known as a food desert. This may mean a person has a more limited diet, and may rely on ready meals and junk food since fresh food is harder to come by.
Ways to help prevent dementia
Individuals cannot change some risk factors, such as age, genetics, or socioeconomic status.
As a national community, we must take responsibility for changing the structural inequalities within healthcare that lead to missed opportunities for diagnosis, poorly funded research, and a lack of understanding of medical care.
But there are also steps individuals can take to reduce their own risk for dementia:
- Eating a healthy, balanced diet: Following the Mediterranean diet, which is rich in fish and vegetables, can lead to improved cognitive function.
- Increasing physical activity: Regular exercise and physical activity may help to reduce the risk of chronic conditions linked to dementia, such as high blood pressure, diabetes, and depression.
- Controlling blood pressure: Keeping high blood pressure under control can lower the risk of stroke and heart disease, both of which have links to dementia.
- Cognitive training: According to the National Institute of Aging, reading, playing games or puzzles, and doing crafts may lower the risk of cognitive impairment.
Learn more about reducing the risk of Alzheimer’s here.
BIPOC are more likely than white people to develop dementia due to a complex combination of factors, such as racism, structural inequality, and socioeconomic barriers to high-quality healthcare.
There is much that organizations and governments can do to reduce inequality in research and healthcare, including addressing the lack of BIPOC participants on medical trials and repairing the residential segregation that many BIPOC face.
But individuals may also be able to reduce their risk for developing dementia by following a healthy diet and lifestyle, controlling the symptoms of chronic conditions, and using games and puzzles to keep their brain alert and healthy.