|by Daniel Pendick
The math couldn’t be simpler — or crueler. African-Americans
make up just 12 percent of the U.S. population, yet they are
twice as likely as whites to develop Alzheimer's
disease and 40 percent less likely to be properly diagnosed
and treated. So when the long-forecasted “Alzheimer’s
bomb” goes off in the aging American population, the faces
will be disproportionately African.
Now, six medical centers around the country are teaming up
with African-Americans to raise awareness about the causes,
symptoms, treatment, and prevention of Alzheimer’s disease.
A true grass-roots effort, the National
African-American Alzheimer’s Disease Health Literacy
Program is working closely with black churches, social
service agencies for seniors, and other community institutions
to get the message out.
Robert P. Friedland, M.D., and colleagues direct the project
from Case Western Reserve
University in Cleveland with grants from Pfizer Inc. and Forest
Laboratories. They are using the money to create health education
programs at Case Western and five other urban areas with large
populations of elderly African-Americans:
Friedland and his colleagues have promoted Alzheimer’s
awareness in the black community since 1994, reaching out
at churches, Sunday schools, shopping malls, community centers,
and even beauty parlors and barbershops. They have also studied
genetic factors in Alzheimer’s disease.
Case Western researchers measured the frequency of an Alzheimer’s
risk gene, ApoE4, in African-Americans and in the Kikuyu ethnic
group of Kenya. But curiously, although the gene is more prevalent
in the native Africans than in African-Americans, the Kikuyu’s
actual risk of developing Alzheimer’s is lower than
in non-Hispanic white and African-Americans.
Surely something is at work besides genes. The scientists
surmised that something about the Kikuyu lifestyle must protect
them from dementia.
There’s a lot of evidence that lifestyle helps to determine
overall risk for Alzheimer’s disease. Cardiovascular
risk factors top the list.
The Kikuyu are physically active vegetarians with low rates
of diabetes, hypertension
(high blood pressure), heart disease, and obesity. In contrast,
cardiovascular disease and stroke are the 1st and 2nd leading
causes of death in African-Americans. One-third of black Americans
have hypertension. High-fat diets, diabetes, and obesity are
The bottom line: Genetic research suggests that elevated Alzheimer’s
risk in African-Americans is largely the result of risk factors
such as hypertension, diabetes, heart disease, high cholesterol,
obesity, smoking, high stress levels, low levels of education,
and lack of participation in mentally stimulating activities.
These risk factors constitute a public health crisis. But
they also represent a recipe for prevention. By addressing
health risk factors, African-Americans can lower their risk
for Alzheimer’s disease while living a longer, healthier
On the grapevine
To help get the message out, Case Western held a public conference
in 2004, “What’z Up on the Grapevine: Memory Loss,
Health, and Research.” They hoped to see 200 people
sign up, but a total of 268 attended and 50 more were on a
waiting list. The conference served as a model for similar
public programs at the other five national project centers.
The Newark project center held its first community meeting
October 17 on the Rutgers University campus. About 200 people
attended the half-day program, including 50 senior-care professionals
from community-based organizations. Speakers discussed Alzheimer’s
disease risk factors, memory fitness and aging, and the importance
of physical fitness to healthy aging.
2008, the Newark program will take the message directly to
African-American seniors in a series of 45-minute lunchtime
presentations at Newark-area churches by the program’s
community coordinator, Peter Amua-Quarshie, M.D. The Case
Western group found such “lunch and learn” programs
a very effective way to educate the community about brain
aging and Alzheimer’s.
Training the trainers
The presentations struck a chord with attendees from the New
Community Corporation, a community development group serving
Newark’s African-American community. Leslie Leonor,
assistant director for community relations, says NCC is developing
a new Alzheimer’s program for residents in seven non-profit
senior housing units in Newark.
“When the doctor diagnoses a patient with the early
stages of dementia, we need to do something to enhance the
resident’s memories,” Leonor explains. “We
see seniors deteriorating and nothing is being done.”
NCC wants its senior residents with dementia to function better
and have a greater understanding of Alzheimer’s disease.
To assist in this effort, four NCC care coordinators will
attend a special seminar March 5 on the Rutgers campus, held
by the Newark project center.
In the seminar, 20 senior care professionals will learn how
to create and conduct community education programs about brain
health and memory fitness. Leading the seminar is Cynthia
Green, Ph.D., an assistant clinical professor at Mount Sinai
School of Medicine in New York and author of Total Memory
Workout: 8 Easy Steps To Maximum Memory Fitness.
At the end of the seminar, the staffers will have the knowledge
and resources to teach community elders about memory fitness.
They will also learn how to recognize memory disorders and
how to refer people for further diagnosis. Michelle Papka,
Ph.D., co-director of the Memory and Cognitive Disorders Program
at the Atlantic Neuroscience Institute at Overlook Hospital
in Summit, New Jersey, will provide this training.
Perhaps the toughest task ahead for the National African-American
Alzheimer’s Disease Health Literacy Program is dispelling
persistent myths in the African-American community that work
against early diagnosis and treatment.
One common misperception is that forgetfulness and disorientation
are “normal” aspects of aging. This makes family
members less likely to seek a doctor’s opinion when
parents or grandparents start to decline mentally. Also, they
may see no point in taking action if they view Alzheimer’s
as an untreatable death sentence.
But if people don’t enter the medical system, they can’t
take advantage of the help doctors can offer. For example,
Alzheimer’s is not the only cause of memory
impairment. It can sometimes be a reversible condition,
or thyroid disease.
Proper testing and medical evaluation can reveal this fact.
However, if the diagnosis is dementia, people can still benefit.
For one thing, patients and their families will have more
time to arrange for proper treatment and caregiving. They
can tap into resources available in the community, such as
education and support services for new caregivers. Alzheimer’s
medications are more likely to benefit the patient earlier
in the course of the disease.
Last but not least, early diagnosis allows for participation
in clinical trials
of new tests and treatments for Alzheimer’s disease
— a chance not only to receive a potentially helpful
treatment, but also to participate in the search for a cure.
Copyright © 2008 Memory Loss and the Brain
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“Ethnic differences in acetylcholinesterase inhibitor
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