Race and Ethnicity in Lewy Body Dementia: A Narrative Review

Abstract

Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson’s disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer’s disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.

Metallomic analysis of brain tissues distinguishes between cases of dementia with Lewy bodies, Alzheimer’s disease, and Parkinson’s disease dementia

“…Another limitation of this study is the lack of racial and ethnic diversity, with only one non-White donor in the current cohort. It is important to recognise that the recruitment of non-White tissue donors needs to improve, in order to investigate the reasons for observed differences in the presentation ( Kurasz et al, 2020 ) and diagnosis ( Kurasz et al, 2022 ; Bayram et al, 2023 ) of LBDs that have been noted in different racial/ethnic groups.…”

Lewy body dementia: Overcoming barriers and identifying solutions

“…Most findings stem from studies including people identifying as non‐Hispanic White with higher levels of education and more access to resources, the generalizability and applicability of these findings remains questionable. For instance, significant sex and gender differences for the prevalence and impact of underlying Lewy body pathology, 29 and potentially lower diagnostic accuracy in people from minoritized ethnoracial groups 33 need to be better understood. As efforts focus on harmonizing data from cohorts in different centers and countries, 16 outreach to and inclusion of underrepresented communities also needs to be emphasized to support diagnostic and therapeutic advances in DLB.…”

Under-Diagnosis of Dementia with Lewy Bodies in Individuals Racialized as Black: Hypotheses Regarding Potential Contributors

“…Multiple studies using the U.S.-based National Alzheimer Coordinating Center (NACC) database identified that fewer Black participants with pathologic Lewy body disease had a clinical suspicion for Lewy body dementia in life compared to White or Hispanic participants [ 5, 6 ]. Over 96% of participants in clinical trials for Lewy body dementia identify as White [ 7 ].…”