Cross-Ethnic Differences in the Severity of Neuropsychiatric Symptoms in Persons With Mild Cognitive Impairment and Alzheimer's Disease

Salazar, Ricardo; Dwivedi, Alok; Royall, Donald R.

doi:10.1176/appi.neuropsych.15120423

Cited by 36 publications

(24 citation statements)

References 38 publications

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“…Finally, patients showed numerically less behavioral disturbance in Asia than in other regions. Neuropsychiatric symptoms are known to vary among cultures, being influenced by lack of recognition, misinterpretation of certain behaviors, and social stigma [ 33 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

Insights into globalization: comparison of patient characteristics and disease progression among geographic regions in a multinational Alzheimer’s disease clinical program

et al. 2018

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BackgroundGlobalization of clinical trials has important consequences for trial planning and interpretation. This study investigated heterogeneity in patient characteristics and outcomes among world regions in the global idalopirdine Phase 3 clinical program.MethodsData were pooled from three 24-week randomized controlled trials in patients aged ≥ 50 years with mild-to-moderate Alzheimer’s disease (AD) (n = 2506). Patients received idalopirdine (10, 30, or 60 mg/day) or placebo, added to cholinesterase inhibitor treatment. Patients were categorized into the following regions: Eastern Europe/Turkey (n = 759), Western Europe/Israel (n = 709), USA/Canada (n = 444), South America/Mexico (n = 361), Asia (n = 134), and Australia/South Africa (n = 99). For each region, operational characteristics, baseline demographic and clinical characteristics, adverse events, and mean change from baseline to week 24 in clinical rating scale scores (placebo group only) were summarized using descriptive statistics.ResultsCompletion rates were 0.86–0.90 in all regions. Heterogeneity among global regions was evident. Protocol deviations were twice as common in South America/Mexico as in USA/Canada (2.64 vs 1.35 per patient screened). Educational level ranged from 9.2 years in South America/Mexico to 13.4 years in USA/Canada. APOE ε4 carriage was 80.6% in Australia/South Africa, 63.1% in Western Europe/Israel, and < 60% in other regions. Screening Mini–Mental State Examination scores were higher in Eastern Europe/Turkey (18.0) and USA/Canada (17.5) than in other regions (16.9–17.1). Baseline AD Assessment Scale—Cognitive subscale (ADAS-Cog) scores ranged from 24.3 in USA/Canada to 27.2 in South America/Mexico. Baseline AD Cooperative Study—Activities of Daily Living, 23-item version (ADCS-ADL23) scores ranged from 58.5 in USA/Canada to 53.5 in Eastern Europe/Turkey. In the placebo group, adverse events were 1.6–1.7 times more common in Western Europe/Israel, USA/Canada, and Australia/South Africa than in Eastern Europe/Turkey. On the ADAS-Cog, Australia/South Africa and Western Europe/Israel showed the most worsening among patients receiving placebo (1.56 and 1.40 points, respectively), whereas South America/Mexico showed an improvement (−0.71 points). All regions worsened on the ADCS-ADL23, from −3.21 points in Western Europe/Israel to −0.59 points in Eastern Europe/Turkey.ConclusionsRegional heterogeneity—in terms of study conduct, patient characteristics, and outcomes—exists, and should be accounted for, when planning and conducting multinational AD clinical trials.Trial registrationClinicalTrials.gov, NCT01955161. Registered on 27 September 2013.ClinicalTrials.gov, NCT02006641. Registered on 5 December 2013.ClinicalTrials.gov, NCT02006654. Registered on 5 December 2013.

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Section: Discussionmentioning

confidence: 99%

Insights into globalization: comparison of patient characteristics and disease progression among geographic regions in a multinational Alzheimer’s disease clinical program

et al. 2018

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“…The present results are also consistent with a previous finding of comparable overall levels of behavioral and psychological symptoms in Mexican Americans and non‐Latin Caucasians with MCI. 11 …”

Section: Discussionmentioning

confidence: 99%

“…However, most prior research has been conducted on Caucasians of non‐Latin descent and the few studies of minority groups have had mixed results. 7 , 8 , 9 , 10 , 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

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Neuropsychiatric symptoms in Brazilians with mild cognitive impairment and dementia

Wilson

Capuano

Sampaio

et al. 2021

Alz & Dem Diag Ass & Dis Mo

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Introduction Knowledge is limited about behavioral and psychological symptoms of mild cognitive impairment (MCI) and dementia in racial and ethnic minorities. Methods As part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), we interviewed knowledgeable informants of 2319 older Brazilian decedents (67% white, 11% black, 22% mixed) using the informant portion of the Clinical Dementia Rating Scale to classify MCI and dementia and the Neuropsychiatric Inventory to assess behavioral and psychological symptoms. Results We identified four clusters of neuropsychiatric symptoms: agitation, affect/apathy, psychosis, and behavioral problems. On the Clinical Dementia Rating Scale, 1407 had no cognitive impairment, 180 had MCI, and 732 had dementia. Both MCI and dementia were associated with symptoms in each behavioral/psychological cluster (all P ’s < .001). There was little evidence of racial differences in the association of MCI and dementia with these neuropsychiatric symptoms. Conclusion MCI and dementia are associated with elevated behavioral and psychological symptoms in older black and white Brazilians.

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“…As older Latinxs will increase to 21% of the over 65 population by 2060 ( U.S. Census Bureau, 2018 ), promoting healthy aging among this population is critical. Moreover, Latinxs have a greater risk of developing Alzheimer’s disease and related dementias (ADRD) than non-Hispanic Whites ( Mayeda et al., 2016 ; Wu et al., 2016 ), experiencing dementia symptoms nearly 7 years earlier than non-Hispanic Whites ( Clark et al., 2005 ), and exhibiting higher levels of dementia-related behavioral symptoms ( Salazar et al, 2017 ). Despite their high burden of ADRD, Latinxs are underrepresented in ADRD research ( Gilmore-Bykovskyi et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

The Digital Divide Exacerbates Disparities in Latinx Recruitment for Alzheimer’s Disease and Related Dementias Online Education During COVID-19

Gutiérrez

Cain

Diaz

et al. 2022

Gerontology and Geriatric Medicine

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Latinx adults experience a high burden of dementia. Given that modifiable factors drive dementia disparities, engaging Latinxs in Alzheimer’s disease and related dementias (ADRD) education is critical to address dementia burden among this aging population. Yet, no studies have documented the role of the COVID-19 pandemic on dementia education among Latinxs. This study: (1) elucidates the recruitment and retention processes targeting Latinxs for online educational events during the pandemic; (2) describes facilitators/barriers to participation; and (3) offers lessons learned. We developed online dementia-focused workshops (English and Spanish) and employed a cold-calling approach to invite Latinx participants enrolled in clinical studies ( N = 209). Bivariate tests assessed demographic and cognitive differences between those who recruiters did ( n = 60) and did not ( n = 149) successfully engage. Frequency counts assessed participants’ technological access. Only 8/209 attended the online events; all held university degrees, most reported English as their primary language, and none experienced cognitive impairment. Results underscore how educational attainment, cognitive impairment, language preference, and age intersect to shape recruitment in dementia-focused online education. To promote healthy aging and to ameliorate dementia disparities, barriers to online engagement among older Spanish-speaking Latinxs with cognitive impairment and low educational attainment must be addressed.

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Cross-Ethnic Differences in the Severity of Neuropsychiatric Symptoms in Persons With Mild Cognitive Impairment and Alzheimer's Disease

Cited by 36 publications

References 38 publications

Insights into globalization: comparison of patient characteristics and disease progression among geographic regions in a multinational Alzheimer’s disease clinical program

Insights into globalization: comparison of patient characteristics and disease progression among geographic regions in a multinational Alzheimer’s disease clinical program

Neuropsychiatric symptoms in Brazilians with mild cognitive impairment and dementia

The Digital Divide Exacerbates Disparities in Latinx Recruitment for Alzheimer’s Disease and Related Dementias Online Education During COVID-19

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