A pair of recent studies concluded that Black people are about twice as likely and Hispanic/Latinos are about one and one-half times as likely as whites to have Alzheimer’s or other dementias, and racism is playing a role.

Photo courtesy of the Alzheimer’s Association

Experiences of structural, interpersonal, and institutional racism are associated with lower memory scores and worse cognition in midlife and old age, especially among Black individuals, according to studies reported at a recent Alzheimer’s Association conference.

According to the Alzheimer’s Association 2022 Alzheimer’s Disease Facts and Figures report, Black people are about twice as likely and Hispanic/Latinos are about one and one-half times as likely as whites to have Alzheimer’s or other dementias.

“In order to achieve health equity — as a step toward complete inclusion — individuals and society must identify and reduce racism and other forms of discrimination,” said Carl V. Hill, Ph.D., MPH, chief diversity, equity and inclusion, officer at the Alzheimer’s Association.

“We must create a society in which the underserved, disproportionately affected and underrepresented are safe, cared for and valued.”

In a study of nearly 1,000 middle-aged community-dwelling adults (55% Latinx; 23% Black; 19% White), exposure to interpersonal and institutional racism was associated with lower memory scores, and these associations were driven by Black individuals. Experiences of structural racism were associated with lower episodic memory among all racial and ethnic groups that were included in the study.

“These systemic disparities are related to less access to important health-protecting resources such as high-quality care and social networks that provide valuable health information and support,” said Rev. Miriam J. Burnett, M.D., MDiv, MPH, medical director, African Methodist Episcopal Church International Health Commission.

In a study of 445 Asian, Black, Latino, white and multiracial people 90 and above, individuals who experienced wide-ranging discrimination throughout life had lower semantic memory in late life compared to those who experienced little to no discrimination.

Alzheimer’s study

The various types and experiences of structural racism and discrimination contribute to systemic inequities, including, lower socioeconomic status; lower quality early life education; and less access to healthy food and proper health care. Individually and cumulatively, these factors impact brain health over the life course in Black/African American, Hispanic/Latino, and other communities.

“The consistent and pervasive lack of resources, as well as social and environmental factors, lead to disparities in other health outcomes such as cardiovascular disease and diabetes, which increase the risk for Alzheimer’s and other dementias,” said Adriana Perez, Ph.D., CRNP, ANP-BC, FAAN, FGSA, assistant professor of nursing at University of Pennsylvania School of Nursing and member of the National Association of Hispanic Nurses.

Research suggests interpersonal and structural racism are contributors to racial and ethnic disparities in cognitive aging. However, there’s little understanding of how multilevel racism influences cognition throughout the life course.

“Chronic exposure to racism and interpersonal discrimination among marginalized communities leads to stress that affects the body and influences physiological health, and likely contributes to the development of cognitive decline,” said Jennifer Manly, Ph.D., professor of neuropsychology at Columbia University Irving Medical Center and the senior author of this work. “Overall, our findings indicate that racism impacts brain health and contributes to the unfair burden of Alzheimer’s disease in marginalized groups.”

Discrimination is a fundamental cause of health inequities. However, it is unknown whether discrimination contributes to disparities in cognitive aging among the oldest old, a group sometimes referred to as “super agers.”

Kristen George, Ph.D., assistant professor of epidemiology in the Department of Public Health Sciences at University of California, Davis, and colleagues, examined the relationship of lifetime experiences of major discrimination with cognitive function and decline among a diverse cohort of Asian, Black, White, Latino, and multiracial participants of the Life After 90 (LA90) Study.

Among 468 participants (20.5% Asian; 21.8% Black; 14.5% Latino; 35.7% white; 7.5% multiracial), the average age at enrollment was 93.

Participants completed three cognitive assessments over an average of 1.2 years. Participants reported experiences of major lifetime discrimination via questionnaire and were grouped based on their responses.

The researchers found that participants in first group (workplace discrimination) had higher levels of baseline cognition in domains of executive function and semantic memory compared to second group (no discrimination). The third group (wide-ranging discrimination) had worse semantic memory at baseline compared to the second one. Across the groups, there were no differences in cognitive decline over time.

“These findings highlight that among the oldest old, inequities in cognitive function persist after accounting for experiences of major lifetime discrimination,” said George.

“Despite the incredible longevity of this group, discrimination has an indelible impact on cognitive health, and oldest old adults still stand to benefit from efforts to eliminate and redress health disparities.”