Brain Aging in African-Americans: The Atherosclerosis Risk in Communities (ARIC) Experience

Gottesman, Rebecca F.; Fornage, Myriam; Knopman, David S.; Mosley, Thomas H.

doi:10.2174/1567205012666150701102445

Cited by 35 publications

(35 citation statements)

References 44 publications

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“…Unadjusted box plots of global cortex standardized uptake value ratio (SUVR) by race and APOE e4 genotype We have previously postulated that differences in rates of cognitive decline and dementia by race are due to differences in prevalence of vascular risk factors. 24 The present results do not support significant confounding by current levels of vascular risk factors (including brain microvascular disease) as an explanation for race disparities in amyloid, although we acknowledge that vascular effects are more likely related to decades of exposure than just current levels; the higher brain amyloid levels we find may still be due to longstanding uncontrolled vascular risk factors that are disproportionately present in black compared to white participants, or vascular brain changes not reflected by our markers. To argue that disproportionate vascular disease explains the current findings, vascular risk factors would need to have contributed to elevated brain amyloid, despite lack of evidence for this association.…”

contrasting

confidence: 77%

The ARIC-PET amyloid imaging study

et al. 2016

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Objective: To evaluate differences in amyloid deposition in a community-based cohort without dementia by age, sex, race, education, and APOE e4 allele status. Methods:Recruited from the longitudinal Atherosclerosis Risk in Communities study, 329 participants without dementia, ages 67-88 years, were imaged using florbetapir PET at 3 US community sites (Washington County, Maryland; Forsyth County, North Carolina; and Jackson, Mississippi). Standardized uptake value ratios (SUVRs) were calculated; global cortical SUVR .1.2 was evaluated as the primary outcome. Age, race, sex, education level, and number of APOE e4 alleles were evaluated in multivariable models including vascular risk factors, brain white matter hyperintensity and total intracranial volume, and cognitive status.Results: A total of 141 of the participants (43%) were black. In multivariable models, odds of elevated SUVR was increased in participants with increasing age (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.01-2.65 per 10 years of age) and black race (OR 2.08, 95% CI 1.23-3.51) but did not differ by educational level. Each e4 allele was associated with increased odds of elevated SUVR (OR 2.65, 95% CI 1.61-4.39).Conclusions: In this community-based cohort without dementia, florbetapir uptake is associated with older age and APOE genotype. Black race was associated with higher SUVR, after adjusting for demographics, vascular risk factors, cognitive status, white matter hyperintensity volume, and APOE genotype, with effect sizes nearing those seen for APOE e4. Replication of these findings is needed in other cohorts, and reasons for and consequences of these observed differences by race warrant further study. The prevailing hypothesis behind the pathophysiology of Alzheimer disease (AD) focuses on the accumulation of brain amyloid in b-amyloid (Ab) plaques as a critical mechanism. Use of PET ligands that bind to Ab allows for the evaluation of Ab in persons with or without clinical symptoms. Although a recent meta-analysis reported positive amyloid scans in 10% of healthy 50-to 90-year-old participants, and in 27% of similarly aged adults with mild cognitive impairment (MCI), 1 few studies in persons of European extraction 2,3 have evaluated patterns of Ab deposition using PET, and none in black participants, to our knowledge. Using Ab imaging in a biracial cohort would allow further exploration of racial disparities in dementia etiology.Dementia is more prevalent in blacks than in whites, 4-6 although AD-type neuropathologic findings are found on autopsy with equal prevalence in both groups. 7,8 Thus, a larger component

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contrasting

confidence: 77%

The ARIC-PET amyloid imaging study

et al. 2016

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“…There are many possible explanations for these observations. Black Medicare beneficiaries with PD are at greater risk of both vascular dementia 29 and AD 30 than Whites. Thus, the observed increased odds of dementia medication use among blacks may be due to coexisting vascular dementia, PD+D, or a mixed neurocognitive profile (e.g.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease

et al. 2019

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Importance: Dementia is common in Parkinson disease (PD), but there is little data on dementia treatment patterns or the concomitant use of cholinesterase inhibitors (ACHEI) and anticholinergic medications (ACH), a frank prescribing error. Objective: To determine the prevalence of dementia treatment and to quantify and characterize inappropriate administration of a high-potency ACH (ACHhigh) drug and an ACHEI among persons with PD. Design, Setting and Participants: This cross-sectional analysis included participants in the U.S. Medicare Prescription Program in 2014 diagnosed with Parkinson Disease. Main Outcomes/Measures: Our primary outcomes were (1) prescription fill for a dementia drug (2) concomitant prescription fills for an ACHEI and an ACHhigh drug. Descriptive analyses and multivariable logistic regression models determined the extent to which patient characteristics and comorbid conditions were associated with dementia treatment or with an ACHhigh-ACHEI event. Results: 268,407 Medicare beneficiaries diagnosed with PD met inclusion criteria; 73,093 (27.2%) were prescribed at least one anti-dementia medication. The commonest medication was donepezil (n=46,027; 63.0% of users) followed by memantine (n=30,578, 41.8%), rivastigmine (n=19,278, 26.4%). Compared to whites, dementia medications were more likely to be prescribed to Blacks (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.28–1.38) and Hispanics (AOR 1.28, 95%CI 1.22–1.35) and less likely to be prescribed to Native Americans (AOR 0.62, 95%CI 0.51–0.74). Women were less likely to be prescribed a dementia medication (AOR 0.85, 95%CI 0.84–0.87, compared to men). Of the 64,017 PD patients receiving an ACHEI, 44.5% (n=28,495) had at least one ACHhigh-ACHEI event. Hispanics (AOR 1.11, 95%CI 1.00–1.23) and women (AOR 1.30, 95%CI 1.25–1.35) had greater odds of this ‘never event’. There was statistically significant clustering in the prevalence of this prescribing error (Moran’s I = 0.24; p < 0.001), with clusters of high ACHhigh-ACHEI prevalence in the Southern and Midwestern United States. Conclusions and Relevance: Dementia medication use varies by race and sex among persons with PD. Potentially inappropriate prescribing is common among PD patients being treated for cognitive impairment, and varies substantially by race, sex and geography. These data provide national and local targets for improving care quality and outcomes for persons with PD.

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“…In general, African-Americans have greater cerebral vascular burden than White Americans [139,140]. We also know that cerebral small vessel disease is associated with postural instability and gait disturbance phenotypes, freezing of gait and worse cognitive impairment [141,142].…”

Section: Vascular Diseasementioning

confidence: 99%

Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review

Ben-Joseph

Marshall

Lees

et al. 2019

Journal of Parkinson’s Disease

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The global prevalence of Parkinson's disease is increasing, yet the characteristics, risk factors and genetics of PD in Black, Asian and Hispanic populations is little understood. In this paper we review the published literature on clinical variation in the symptoms and signs of Parkinson's disease in different ethnic groups and responses to treatment. We included any study that sampled patients with Parkinson's disease from distinct ethnic backgrounds. We conclude that whilst there is little published evidence for ethnic variation in the clinical features of Parkinson's disease, there are substantial limitations and gaps in the current literature, which mean that the evidence does necessarily not fit with clinical observation. Possible explanations for expected differences in manifestation include genetic determinants, the coexistence of cerebrovascular disease and/or Alzheimer's disease pathology, healthcare inequalities and socio-cultural factors.

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Brain Aging in African-Americans: The Atherosclerosis Risk in Communities (ARIC) Experience

Cited by 35 publications

References 44 publications

The ARIC-PET amyloid imaging study

The ARIC-PET amyloid imaging study

Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease

Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review

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