Racial Differences in the Pathway to Diagnosis of Alzheimer's Disease and Related Dementias

Abstract This study examined differences in the pathway to diagnosis of Alzheimer's disease and related dementias (ADRD) between Black and White older adults. Using electronic health records from a large health system, we included 2,085 non-Hispanic Black and 6,269 non-Hispanic White older adults with a final/primary diagnosis of ADRD between 2014 and 2020. Black older adults were more likely to receive the ADRD diagnosis from a primary care provider (35.4% vs. 29.8%), during a hospital admission (19.5% vs. 13.6%), or during an emergency department visit (4.2% vs. 2.0%); but were less likely to be diagnosed by an ADRD specialist (31.6% vs. 45.2%). Black older adults had nearly twice as many clinical encounters in the two years prior to the ADRD diagnosis than their White counterparts (43 vs. 26). Despite having more clinical encounters, Black older adults were more likely to be at a later stage when diagnosed than White older adults.

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Intention to Receive Cognitive Screening for Alzheimer’s Disease in Nondemented Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.838 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 261-261

Author(s):

Juyoung Park ◽

Magdalena Tolea ◽

Lilah Besser ◽

James Galvin

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Self Efficacy ◽

Public Awareness ◽

Mediating Effect ◽

Cognitive Screening ◽

Life Orientation ◽

To Receive ◽

The Relationship

Abstract The study explored factors associated with intention to receive cognitive screening for Alzheimer’s disease (AD). It also examined whether self-efficacy mediates the relationship between knowledge about screening and the intention to be screened. A population-based, random-digit dialing survey was performed; 1,043 responses were collected from a sample of nondemented older adults living in urban, suburban, and rural areas. A majority were female (66.8%, n = 697) and White (82.7%, n = 863) with a mean age 62.6 years (SD = 10.2). Findings from regression analysis identified that being female (β = .080), being depressed (β = .149), and having a positive life orientation (β = .120) were significantly associated with the intention to receive cognitive screening, p < .05. Results indicated that older adults with a positive life orientation reported greater intention to be screened for AD, whereas depressed participants were more likely to plan to be screened for AD. Bootstrapping results identified a mediating effect of self-efficacy (β = .2668, t = 7.3137, p < .0005). Self-efficacy mediated the relationship between knowledge about screening and intention to be screened. Using self-efficacy as a mediation effect indicated that older adults with knowledge about screening understand the benefits of early screening and diagnosis and are more likely to have self-efficacy (i.e., confidence to consult with a physician), and thus are more likely to show intention to be screened. Intention to be screened for AD could increase public awareness by defining effective ways to assist older adults to seek a cognitive screen.

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LIFESTYLE BEHAVIORS AND RACIAL DIFFERENCES IN ALZHEIMER’S DISEASE RISK

Innovation in Aging ◽

10.1093/geroni/igz038.1748 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S468-S469 ◽

Cited By ~ 1

Author(s):

Roger Wong

Keyword(s):

Physical Activity ◽

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Racial Differences ◽

Disease Risk ◽

Cox Proportional Hazards Model ◽

Lifestyle Behaviors ◽

Social Contacts ◽

Blacks And Whites

Abstract There is substantial evidence indicating that among all racial groups, Blacks have the highest Alzheimer’s disease (AD) risk. Despite the wide support for this disparity, the reasons for these racial differences in AD risk remain unclear. The purpose of this study was to examine how lifestyle behaviors (physical activity, smoking, and social contacts) mediate and moderate the relationship between race and AD risk among Black and White older adults. This study used seven annual waves (2011-2017) of prospective data from the National Health and Aging Trends Study (NHATS), a large nationally representative U.S. sample of older adults. At each wave, physical activity was measured as whether they engaged in vigorous physical activities; smoking was measured as whether they were cigarette smokers; and social contacts was measured as whether they visited friends/family outside of their home. The dependent variable was age of AD diagnosis. Multivariate analyses were conducted using the Cox proportional hazards model. Blacks had a 1.3 times significantly higher risk for AD compared to Whites (Hazard Ratio [HR]=1.31, p=.03). After controlling for lifestyle behaviors as a mediator, racial differences in AD risk were attenuated and no longer significantly different between Blacks and Whites (HR=1.05, p=.74). For the moderation model, interactions between race and each lifestyle behavior generated no statistically significant results. Our findings indicate lifestyle behaviors contribute to racial differences in AD risk between Blacks and Whites. Future research is needed among Black populations to identify specific lifestyle behaviors that are especially protective against AD as targets of intervention.

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Cognitive control constrains memory attributions

Behavioral and Brain Sciences ◽

10.1017/s0140525x19001869 ◽

2019 ◽

Vol 42 ◽

Author(s):

Colleen M. Kelley ◽

Larry L. Jacoby

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Control

Abstract Cognitive control constrains retrieval processing and so restricts what comes to mind as input to the attribution system. We review evidence that older adults, patients with Alzheimer's disease, and people with traumatic brain injury exert less cognitive control during retrieval, and so are susceptible to memory misattributions in the form of dramatic levels of false remembering.

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Partner-Specific Communication Deficits in Individuals With Alzheimer's Disease

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00094 ◽

2020 ◽

pp. 1-15

Author(s):

Eun Jin Paek ◽

Si On Yoon

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Referential Communication ◽

Sorting Task ◽

Audience Design ◽

Healthy Older Adults ◽

Communication Task ◽

Design Skills ◽

Referential Expressions

Purpose Speakers adjust referential expressions to the listeners' knowledge while communicating, a phenomenon called “audience design.” While individuals with Alzheimer's disease (AD) show difficulties in discourse production, it is unclear whether they exhibit preserved partner-specific audience design. The current study examined if individuals with AD demonstrate partner-specific audience design skills. Method Ten adults with mild-to-moderate AD and 12 healthy older adults performed a referential communication task with two experimenters (E1 and E2). At first, E1 and participants completed an image-sorting task, allowing them to establish shared labels. Then, during testing, both experimenters were present in the room, and participants described images to either E1 or E2 (randomly alternating). Analyses focused on the number of words participants used to describe each image and whether they reused shared labels. Results During testing, participants in both groups produced shorter descriptions when describing familiar images versus new images, demonstrating their ability to learn novel knowledge. When they described familiar images, healthy older adults modified their expressions depending on the current partner's knowledge, producing shorter expressions and more established labels for the knowledgeable partner (E1) versus the naïve partner (E2), but individuals with AD were less likely to do so. Conclusions The current study revealed that both individuals with AD and the control participants were able to acquire novel knowledge, but individuals with AD tended not to flexibly adjust expressions depending on the partner's knowledge state. Conversational inefficiency and difficulties observed in AD may, in part, stem from disrupted audience design skills.

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Auditory Dysfunction in Alzheimer's Disease

Perspectives on Gerontology ◽

10.1044/gero15.1.4 ◽

2010 ◽

Vol 15 (1) ◽

pp. 4-11 ◽

Cited By ~ 1

Author(s):

Sridhar Krishnamurti

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Health Care ◽

Care Setting ◽

Neurodegenerative Disorder ◽

Disease Process ◽

Clinical Protocols ◽

Speech Language Pathologist ◽

Auditory Dysfunction

Alzheimer's disease is neurodegenerative disorder which affects a growing number of older adults every year. With an understanding of auditory dysfunction in Alzheimer's disease, the speech-language pathologist working in the health care setting can provide better service to these individuals. The pathophysiology of the disease process in Alzheimer's disease increases the likelihood of specific types of auditory deficits as opposed to others. This article will discuss the auditory deficits in Alzheimer's disease, their implications, and the value of clinical protocols for individuals with this disease.

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