Minority Ethnic Groups and Dementia PDF

**[Minority Ethnic Groups and Dementia]** **Risk Factors for Dementia:** - APOE -4 increases the risk threefold in those with one copy of the allele and 8-10-fold in homozygotes. - High LDL cholesterol **Environmental Risk Factors Across Ethnicities** - Obesity, hypertension, diabetes...

**[Minority Ethnic Groups and Dementia]** **Risk Factors for Dementia:** - APOE -4 increases the risk threefold in those with one copy of the allele and 8-10-fold in homozygotes. - High LDL cholesterol **Environmental Risk Factors Across Ethnicities** - Obesity, hypertension, diabetes more common in South Asian people. - Hypertension increased in Black population - Impact of hypertension, obesity, diabetes, low HDL and sleep disorders on dementia risk was increased in South Asian people compared to White people. - Impact of hypertension was greater in Black compared to White people. - More deprived areas have higher air pollution, often higher minority ethnic density. **PAF Differences Between Countries** - Latin America has a 58% potentially modifiable PAF. - India has a 42% potentially modifiable PAF. - China has a 42% potentially modifiable PAF. **Genetic Risk Factors Across Ethnicities** - Prevalence of different alleles varies across different populations with a lower prevalence in East Asian in those with Alzheimer's dementia (around 40%) compared with European populations (around 60%). - Absence of the E4 allele in the Koch tribal population in central India and very low frequency in Indian populations. Generally, ½ frequency compared to European populations. Heterozygosity is more common in UK than in the Indian population. - Mixed evidence for role of APOE -E4 in Hispanics and African Americans. - No association has been found between APOE and dementia in older people in Nigeria. **Prevalence of Dementia Across Ethnicities** - Around 7% of over 60's and 6.5% of over 65s in Western Europe have dementia. - Declining prevalence over past 20 years. - African-Caribbean participants with dementia nearly 8 years younger than White counterparts. The prevalence of dementia was significantly higher in African-Caribbean (9.6% in over 60s) than White group after adjustment for the confounders age and socioeconomic status. - South Asians have similar or higher prevalence compared to the White British population. - In USA: - African American people have a higher incidence of dementia (26.6/1000 person years) compared to the White population (19.3/1000 person years). - East Asian Americans (15.2/1000 person years). - Country of Origin: - Prevalence estimates of dementia in China similar to Europe and higher in India but depends on how diagnosed. - Estimates of dementia prevalence in sub-Saharan Africa are lower and northern Africa are similar to Europe. Prevalence is more similar to Europe if use 10/66 dementia diagnosis not DSM-IV. **Diagnosis** - Late in BAME groups. - Usually in a crisis situation. - Many don't get diagnosed. - Worse outcomes. **ACE Cultural Adaptations** - Variability in reporting of translation and cultural adaptation procedures. **Outcomes After Dementia** - Higer risk of death after dementia diagnosis in Black and South Asian people. - Shorter survival (\~3 years less) after dementia diagnosis in Black and South Asian people compared to White. - Survival after diagnosis, Whites had shortest median survival (3.1 years), followed by Native Americans/ Alaska Natives (3.4 years), African Americans (3.7 years), Latinos (4.1 years), and Asian Americans (4.4 years).