PASADENA, Calif., May 15, 2024
/PRNewswire/ -- Huntington Medical Research Institutes (HMRI),
a pioneer in scientific research dedicated to unraveling diseases
of the heart and brain, gains new insights into dementia among
American Indians for the first time through a landmark study led by
renowned epidemiologist Astrid
Suchy-Dicey, PhD, Associate Professor, and Scientific
Director, Clinical and Translational Neurosciences.
"Overall, our findings emphasize the
importance of inclusive Alzheimer's disease and dementia research,
representing all populations."
This is the first large, prospective, population-based study to
estimate the prevalence of vascular and Alzheimer's dementias
in American Indians, using a gold-standard method of cognitive
determination consistent with protocols used by National
Alzheimer's Coordinating Center Alzheimer's Disease Research
Centers and as recommended by National Institute on Aging and
Alzheimer's Association. This report, "Epidemiology and prevalence
of dementia and Alzheimer's disease in American Indians: data from
the Strong Heart Study," was published today in Alzheimer's and
Dementia: The Journal of the Alzheimer's Association.
Until recently, the epidemiology of Alzheimer's disease and
related dementias among American Indians and other Indigenous
peoples has been critically underrepresented in mainstream dementia
research. Disparities in socioeconomics, historical, and
sociological factors increase risk, resulting in disparate
prevalence and incidence of disease. American Indians endure a high
prevalence of contributing comorbidities, such as hypertension,
diabetes, and depression, exacerbated by relatively poorer access
to socioeconomic resources. Suchy-Dicey cautions, "interpretation
of race-based differences [in health disparities research] should
be done with caution; such differences probably have more to do
with social determinants than with biological differences."
Previous data using administrative and health records estimated
dementia prevalence in American Indians and Alaska Natives as
similar to that of non-Hispanic Whites. However, this prospectively
conducted, population-based study detected higher prevalence --
with approximately half of American Indians over age 65 affected by
some cognitive impairment, and approximately 10% with dementia.
These epidemiologic findings are thought to be an improvement on
prior research because they are not limited by underreporting of
cases in the clinical context. Records-based research may be prone
to data or information bias, due to inadequate or late care, poor
specialty access in rural regions, and poor cultural sensitivity in
some contexts. It is estimated that up to 50% of those with
dementia may be missing notations in their medical records, further
increasing disparities for those who experience barriers to care,
and compounding problems for research on racial-ethnic disparities
using such data. Thus, prior studies that are not population-based,
with prospectively collected, objective, and sensitive methods for
case identification may represent underestimates of true prevalence
and incidence in these populations. So far, the data in this report
is the closest to gold-standard epidemiologic estimates of dementia
prevalence for American Indians.
Additionally, this study reported novel findings that vascular
brain injury was equally important to Alzheimer's disease in
etiology, both as independent contributors but also with
substantive overlap between them. This suggests a continued need
for vascular prevention in this population, which may be lagging
behind the majority population in reduction and prevention of
cardiovascular disease (CVD) and cerebrovascular disease (CBVD).
Future studies will investigate whether primary prevention of
vascular disease could result in decreased prevalence and incidence
of dementia in this population.
Finally, traumatic head injury was found to be a significant
contributor among "other" impairments, perhaps representing acute
cognitive changes. These findings echo prior research on blood
biomarker findings, which detected higher prevalence of markers for
neuronal remodeling in this population than expected. More
follow-up is needed, but this may be an important factor to
consider in future dementia research, especially in American
Indians and other minoritized groups.
"Overall, our findings emphasize the importance of inclusive
Alzheimer's disease and dementia research, representing all
populations, and especially with data gathering that is sensitive
and knowledgeable to that particular group," said Suchy-Dicey. "We
hope these findings will be useful to clinicians and researchers,
especially those interested in health disparities."
Suchy-Dicey collaborated with University of
Washington School of Medicine colleagues Kimiko Domoto-Reilly, MD, Suman Jayadev, MD, Thomas J Grabowski, MD, and
Kristoffer Rhodas, PhD, and with
Dedra S. Buchwald, MD and
Lonnie Nelson, PhD, of Washington State University. Data and participants
are from the Strong Heart Study, and part of a growing body of work
on Alzheimer's disease and vascular dementias in this otherwise
critically-understudied population. This study has been funded in
whole or in part with federal funds from the National Institutes of
Health, including the National Heart, Lung, and Blood Institute and
National Institute on Aging, including R01HL093086 (Buchwald),
P50AG005136 (Grabowski), K01AG057821 (Suchy-Dicey).
More information: Astrid M.
Suchy-Dicey et al, Epidemiology and prevalence of
dementia and Alzheimer's disease in American Indians: data from the
Strong Heart Study, Alzheimer's and Dementia: The Journal of the
Alzheimer's Association (2024).
https://doi.org/10.1002/alz.13849
About HMRI
Based in Pasadena, California, Huntington Medical
Research Institutes (HMRI) is a pioneer in scientific research with
a 70-year track record of groundbreaking discoveries that have
changed the world – from seatbelts to lifesaving diagnostic
technology like the MRI. Today, HRMI is laser-focused on biomedical
research that investigates diseases of the heart and brain, and it
is committed to inspiring and educating the next generation of
scientists.
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