Implications of Risk Factors for Alzheimer’s Disease in Canada’s Indigenous Population

Abstract

BackgroundIndigenous peoples in Canada have higher prevalence of modifiable risk factors for Alzheimer’s disease (AD). The relative importance of these risk factors on AD risk management is poorly understood.MethodsRelative risks from literature and prevalence of risk factors from Statistics Canada or the First Nations Regional Health Survey were used to determine projected population attributable risk (PAR) associated with modifiable risk factors for AD (low education and vascular risk factors) among on- and off-reserve Indigenous and non-Indigenous people in Canada using the Levin formula.ResultsPhysical inactivity had the highest PAR for AD among Indigenous and non-Indigenous peoples in Canada (32.5% [10.1%–51.1%] and 30.5% [9.2%–48.8%] respectively). The PAR for most modifiable risk factors was higher among Indigenous peoples in Canada, particularly among on-reserve groups. The greatest differences in PAR were for low educational attainment and smoking, which were approximately 10% higher among Indigenous peoples in Canada. The combined PAR for AD for all six modifiable risk factors was 79.6% among on-reserve Indigenous, 74.9% among off-reserve Indigenous, and 67.1% among non-Indigenous peoples in Canada. (All differences significant to p < .001.)ConclusionsModifiable risk factors are responsible for the most AD cases among Indigenous peoples in Canada. Further research is necessary to determine the prevalence of AD and the impact of risk factor modification among Indigenous peoples in Canada.

An Estimate of Attributable Cases of Alzheimer Disease and Vascular Dementia due to Modifiable Risk Factors: The Impact of Primary Prevention in Europe and in Italy

“…Almost 30.5% (305,000 cases) of prevalent cases of AD in Germany may be currently attributable to considered risk factors, assuming such factors to be independent [ 31 ]. Three more studies have recently been published enrolling populations residing in the Netherlands, Iran, and Canada [ 32 , 33 , 34 ], but we could not compare their data with ours due to differences in the methodology used, including the choice of the risk factors to be considered.…”

“Place-ing” Dementia Prevention and Care in NunatuKavut, Labrador

“…Dementia risk in Indigenous communities relates to disparities in the social determinants of health, including poverty and low educational attainment, higher rates of associated diseases (hypertension, stroke, diabetes, cardiovascular disease) and higher rates of smoking and obesity, which may put Indigenous groups at elevated risk for developing dementia, particularly vascular dementias (Jacklin et al, 2013; Loppie-Reading & Wein, 2009). High rates of head injury, childhood stress, and post-traumatic stress disorder (PTSD) relating to historical trauma may also be contributing factors (Henderson & Broe, 2010; Petrasek Macdonald, Barnes, & Middleton, 2015; Radford et al, 2017). The effects of colonialism, including sedentarization, dispossession of land, and the long-term effects of the residential school system have additionally impacted Indigenous peoples’ health (Czyzewski, 2011).…”

Future Directions for Dementia Risk Reduction and Prevention Research: An International Research Network on Dementia Prevention Consensus

“… Evidence is lacking on specific population groups and cultures within populations. Within countries and cohort studies it is possible that risk exposure, risk effects and protective mechanisms (e.g., cognitive resilience, cognitive reserve, coping mechanisms and strategies) vary within subgroups (e.g., indigenous populations in Australia [ 24 ], Canada and United States [ 25 ]; racial minorities in the United States (e.g., African Americans, Asian Americans [ 26 ]); and neuro-diverse populations (e.g., autism spectrum disorder [ 27 ])). These populations are often overlooked due to the need to aggregate data for publication or high-level policy reports.…”