Racial Differences in Neuropsychiatric Symptoms Among Dementia Patients: A Comparison of African Americans and Whites

2000 ◽  
Vol 12 (S1) ◽  
pp. 395-402 ◽  
Author(s):  
Carl I. Cohen
Keyword(s):  
African American ◽  
Nursing Home ◽  
African Americans ◽  
Racial Differences ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Sociodemographic Variable ◽  
Behavioral Disturbances ◽  
Dementia Patients ◽  
Nursing Home Patients

Race is a critical sociodemographic variable that may serve as a marker for genetic, clinical, cultural, and socioeconomic factors. There have been several studies that found differences between African Americans and Whites in the neuropsychiatric symptoms of dementia. There have been fairly consistent findings that psychotic symptoms—hallucinations and delusions—are more prevalent among African American patients with dementia (Cohen & Carlin, 1993; Cooper et al., 1991, Deutsch et al., 1991; Fabrega et al., 1988), and that depression is higher among Whites than among African Americans (Fabrega et al., 1988; Walker et al., 1995). One study by Class and colleagues (1996) also suggested that behavioral disturbances might be higher among White than among African American nursing home patients, a majority of whom had dementia.

scholarly journals RACIAL DIFFERENCES IN NON-COGNITIVE SYMPTOMS IN ALZHEIMER’S DISEASE AND CAREGIVER DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S857-S857
Author(s):  
Weizhou Tang
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
African American ◽  
African Americans ◽  
Ethnic Groups ◽  
Racial Differences ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Symptoms ◽  
Significant Group ◽  
Caregiver Depression

Abstract Behavioral and psychological symptoms (BPS) represent a heterogeneous group of non-cognitive symptoms occurring in persons with Alzheimer’s disease (PwAD), and they are often associated with negative outcomes for AD caregivers. Evidence indicates differences in caregivers’ mental health across race/ethnic groups. However, there is a lack of research that compares racial differences in BPS in PwAD. This study aims to compare racial differences in BPS in PwAD and caregiver depression. The study analyzed data collected from the South Carolina AD Registry in 2010. The survey used in the interview included measures of caregiver depression, caregiver burden, PwAD’s non-cognitive symptoms, caregiving competence, caregiver distress, and demographics. The final analysis focused on 635 African-American (n=313) and white (n=322) caregivers. Mann-Whitney U-tests, Chi-square tests, and multiple linear regression were conducted. Among all PwAD, higher percentage of whites than African Americans exhibited apathy/indifference (67.52% vs 52.44%, p=.0001), depression/dysphoria (61.54% vs 44.59%, p<.0001), and anxiety (45.08% vs 29.64%, p<.0001). In terms of both frequency and severity of BPS, whites had significantly higher BPS score (Mean=35.49, SD=24.75) than African Americans (Mean=28.13, SD=23.97; p<.0001). Mean comparisons indicated significant group differences in caregiver depressive symptoms between white caregivers (mean=11.89, SD=6.90) and African-American caregivers (mean=9.41, SD=5.77). However, there were no racial differences in the relationship between BPS in PwAD and caregiver depression. The findings of this study highlight the importance of developing more effective and targeted treatment options and therapies for neuropsychiatric symptoms and delivering cultural relevant education programs/interventions to ethnic groups.

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

Racial Differences in Motivators and Barriers to Blood Donation Among Blood Donors

2009 ◽  
Vol 133 (9) ◽  
pp. 1444-1447
Author(s):  
Beth H. Shaz ◽  
Derrick G. Demmons ◽  
Krista L. Hillyer ◽  
Robert E. Jones ◽  
Christopher D. Hillyer
Keyword(s):  
African American ◽  
African Americans ◽  
Racial Differences ◽  
Blood Donors ◽  
Blood Donation ◽  
Screening Process ◽  
Center Staff ◽  
Predominately White ◽  
Donation Frequency ◽  
The Right

Abstract Context.—Nationally, African Americans are underrepresented in community blood donation programs. To increase blood donation by African Americans, differences between motivators and barriers to blood donation between races should be investigated. Objective.—To investigate motivators and barriers to blood donation in African American and white blood donors. Design.—An 18-item, anonymous, self-administered questionnaire regarding demographics and motivators and barriers to donation was completed by blood donors at a predominately African American and a predominately white fixed donation site. Results.—A total of 599 participants (20% African American, 75% white, and 5% other) completed the survey. The most commonly reported reasons to donate included: “because it is the right thing to do” (45% African Americans and 62% white) and “because I want to help save a life” (63% African Americans and 47% white). Unpleasant experiences did not differ as a barrier to continue donation between African Americans and whites. African Americans placed more importance on donating blood to someone with sickle cell disease, convenience of blood donation, treatment of donor center staff, and level of privacy during the screening process. Conclusions.—These data suggest that in a large metropolitan area, reasons for donation among African American and white donors differ. To retain and increase donation frequency of African American donors, these factors should be considered in creating an African American donor recruitment and retention program.

Abstract 3060: Racial Disparities in Early Institution of “Do Not Resuscitate” Orders Influence Survival in Acute Ischemic Strokes.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Pratik Bhattacharya ◽  
Ambooj Tiwari ◽  
Sam Watson ◽  
Scott Millis ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
Critical Care ◽  
African American ◽  
Ischemic Stroke ◽  
African Americans ◽  
Acute Ischemic Stroke ◽  
Racial Differences ◽  
Racial Disparity ◽  
Retrospective Chart Review ◽  
Do Not Resuscitate ◽  
Dnr Orders

Background: The importance of early institution of “Do Not Resuscitate” (DNR) orders in determining outcomes from intracerebral hemorrhage is established. In the setting of acute ischemic stroke, African Americans tend to utilize critical care interventions more and palliative care options less than Caucasians. Recent epidemiological studies in acute ischemic stroke have shown a somewhat better survival for African Americans compared with Caucasians. Our hypothesis was that racial differences in early institution of DNR orders would influence mortality in acute ischemic stroke. Methods: a retrospective chart review was conducted on consecutive admissions for acute ischemic stroke across 10 hospitals in Michigan for the year 2006. Subjects with self reported race as African American or Caucasian were selected. Demographics, stroke risk factors, pre morbid status, DNR by day 2 of admission, stroke outcome and discharge destination were abstracted. Results: The study included 574 subjects (144 African American, 25.1%; 430 Caucasian, 74.9%). In-hospital mortality was significantly higher among Caucasians (8.6% vs. 1.4% amongst African Americans, p=0.003). More Caucasians had institution of DNR by day 2 than African Americans (22.5% vs. 4.3%, p<0.0001). When adjusted for racial differences in DNR by day 2 status, Caucasian race no longer predicted mortality. Caucasians were significantly older than African Americans (median age 76 vs. 63.5 years, p<0.0001); and age was a significant predictor of DNR by day 2 and mortality. In the adjusted analysis, however, age marginally influenced the racial disparity in mortality ( table ). Caucasians with coronary disease, atrial fibrillation, severe strokes and unable to walk prior to the stroke tend to be made DNR by day 2 more frequently. Only 27.1% of Caucasians with early DNR orders died in the hospital, whereas 20.8% were eventually discharged home. Conclusions: Early DNR orders result in a racial disparity in mortality from acute ischemic stroke. A substantial proportion of patients with early DNR orders eventually go home. Postponing the use of DNR orders may allow aggressive critical care interventions that may potentially mitigate the racial differences in mortality.

Spirituality among African Americans

2021 ◽  
pp. 154-176
Author(s):  
Jason E. Shelton
Keyword(s):  
African American ◽  
Comparative Analysis ◽  
African Americans ◽  
Personal Identity ◽  
Racial Differences ◽  
National Survey ◽  
African American Community ◽  
Black And White ◽  
Spiritual But Not Religious ◽  
Blacks And Whites

This chapter assesses the importance of spirituality among African Americans. More specifically, it examines the extent to which respondents in a large, multiyear national survey view themselves as a “spiritual person.” Four sets of comparative analysis are offered: (1) racial differences among black and white members of various evangelical Protestant traditions, (2) racial differences among black and white members of various mainline Protestant and Catholic traditions, (3) denominational differences specifically among African Americans, and (4) racial differences among blacks and whites who view themselves as “spiritual but not religious.” The findings reveal significant interracial and intraracial differences in how spirituality shapes one’s personal identity. Because organized religion has historically been so central to African American community life, the implications for the growth in noninstitutional spirituality are considered.

scholarly journals Natural course of neuropsychiatric symptoms in nursing home patients with mental-physical multimorbidity in the first eight months after admission

2018 ◽  
Vol 24 (1) ◽  
pp. 155-161
Author(s):  
Anne van den Brink ◽  
Debby L. Gerritsen ◽  
Miranda M.H. de Valk ◽  
Richard Oude Voshaar ◽  
Raymond Koopmans
Keyword(s):  
Nursing Home ◽  
Neuropsychiatric Symptoms ◽  
Natural Course ◽  
Nursing Home Patients

Fourteen Percent of Healthy African Americans Participating In the Zimmerman Program for the Molecular and Clinical Biology of VWD (ZPMCB VWD) Are Heterozygous for the VWF Gene Mutation H817Q Associated with Type 2N Von Willebrand Disease

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 239-239
Author(s):  
Kenneth D Friedman ◽  
Daniel B. Bellissimo ◽  
Pamela A. Christopherson ◽  
Veronica H Flood ◽  
Joan Cox Gill ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Racial Differences ◽  
Healthy Subjects ◽  
Von Willebrand Disease ◽  
Compound Heterozygous ◽  
Healthy Controls ◽  
Clinical Biology ◽  
A1 Domain ◽  
Von Willebrand

Abstract Abstract 239 Von Willebrand disease (VWD) is a common hereditary bleeding disorder caused by reduced concentration or abnormal structure/function of von Willebrand Factor (VWF). Most published studies of normal VWF have been carried out in European or North American subjects without regard to racial differences. In the process of studying healthy controls in the Zimmerman Program for the Molecular and Clinical Biology of VWD (ZPMCB-VWD), we identified a common polymorphism (D1472H) in the VWF A1-domain in African Americans that affects the measurement of VWF function by ristocetin cofactor (VWF:RCo) but does not appear associated with increased bleeding risk. We therefore explored whether other polymorphisms or mutations were identified more frequently in African Americans. VWF sequencing was performed on 191 healthy controls including 66 that were self-identified as African American. European Bleeding Score was obtained and normal in all healthy subjects. Among the African Americans, 9 individuals were heterozygous for the reported type 2N H817Q mutation and one was homozygous. Factor VIII binding to VWF (VWF:F8B) was determined with a standard FVIII binding assay using the subject's plasma VWF and recombinant FVIII. The VWF:F8B was significantly reduced in H817Q heterozygotes when compared to 10 healthy study subjects without the H817Q mutation (65 ± 11 versus 108 ± 11, p=0.003). The VWF:F8B was further reduced to 37 using the plasma VWF from the homozygous H817Q subject. However, the observed VWF:F8B in these individuals with H817Q are still considerably higher that that observed in patients enrolled in ZPMCB-VWD that are either homozygous or compound heterozygous with the common R854Q type 2N VWD (VWF:F8B < 13). Of the 116 self-identified Caucasian healthy subjects, none had the H817Q mutation, but 3 were heterozygous for the R854Q mutation; their mean plasma VWF:F8B was reduced to 51. While the homozygous R854Q patients had reduced plasma FVIII levels (mean FVIII=24 IU/dL), none of the sequenced healthy control subjects had plasma FVIII levels below 53 IU/dL, Some have advocated FVIII/VWF:Ag ratios as a screen for type 2N VWD. The subject with homozygous H817Q had only a mildly reduced FVIII/VWF:Ag ratio (0.59), while the heterozygous H817Q were not reduced (mean=0.90), thereby demonstrating that the VWF:F8B assay has greater sensitivity for type 2N VWF binding defects than the FVIII/VWF:Ag ratio. Since the previously reported A1-domain D1472H polymorphism was common in African Americans, we explored the prevalence of this polymorphism in the healthy subjects with the H817Q mutation. All H817Q heterozygous subjects were either homozygous (4) or heterozygous (5) for the D1472H polymorphism. The one individual who was H817Q homozygous was also D1472H homozygous, suggesting that there may be an extended haplotype present in African Americans. In summary, an H817Q type 2N mutation is commonly found in healthy African American subjects with an allele frequency of 0.083, predicting that approximately 7 in 1,000 African Americans would be homozygous for the H817Q type 2N mutation. Our data, and the rarity of diagnosis of type 2N VWD in African Americans suggests that while mutation H817Q may interfere with the interaction of FVIII with VWF, this mutation appears to confer little or no clinical symptoms. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Pneumonia in Nursing Home Patients With Advanced Dementia: Decisions, Intravenous Rehydration Therapy, and Discomfort

2017 ◽  
Vol 35 (3) ◽  
pp. 423-430 ◽  
Author(s):  
Jenny T. van der Steen ◽  
Paola Di Giulio ◽  
Fabrizio Giunco ◽  
Massimo Monti ◽  
Simona Gentile ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Symptom Relief ◽  
Advanced Dementia ◽  
Palliative Intent ◽  
Physician Decision Making ◽  
Intravenous Rehydration ◽  
Dementia Patients ◽  
Nursing Home Patients ◽  
Trained Observers

Background: Comfort may be an appropriate goal in advanced dementia. Longitudinal studies on physician decision-making and discomfort assessed by direct observation are rare, and intravenous rehydration therapy is controversial. Methods: To assess treatment decisions and discomfort in patients with advanced dementia and pneumonia and to compare by intravenous rehydration therapy, we used data from the observational multicenter Italian End of Life Observatory–Prospective Study On DEmentia patients Care. We analyzed 109 episodes of pneumonia, which involved decisions in 77 nursing home patients with Functional Assessment Staging Tool stage 7. We assessed decisions, decision-making, and treatments every fortnight. Trained observers assessed discomfort with the Discomfort Scale–Dementia Alzheimer Type (DS-DAT). Results: Most decisions referred to treatment with antibiotics (90%; 98 of 109) and intravenous rehydration therapy (53%; 58 of 109), but hospitalization was rare (1%). Selecting decisions with antibiotics, with rehydration therapy, the prognosis was more frequently <15 days (34% vs 5% without rehydration therapy; P = .001), and a goal to reduce symptoms/suffering was more common (96% vs 74%; P = .005) while there was no difference in striving for life prolongation (a minority). With rehydration therapy, the decision was more often discussed with family rather than communicated only. Mean DS-DAT scores over time proximate to the first decision ranged between 9.2 and 10.5. Conclusions: Italian nursing home patients with advanced dementia and pneumonia frequently received invasive rehydration therapy in addition to antibiotics, however, mostly with a palliative intent. Discomfort was high overall and symptom relief may be improved. Relations between invasive rehydration therapy and discomfort need further study.

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