Minorities Receive Less Timely Dementia Diagnoses Than Whites

An accompanying editorial in JAMA Neurology noted that the study apparently is the first to focus on disparities related to “time to diagnosis and comprehensiveness of evaluation” of dementia. Claudia Kawas, M.D., a geriatric neurologist and researcher at the University of California, Irvine, and other authors of the editorial noted that they were surprised to find that despite having Medicare insurance, most beneficiaries did not receive a comprehensive “workup” including neuroimaging, laboratory blood assays and specialty referrals for their MCI or dementia diagnoses.

"The absence of workup was particularly true for those who were older and had multiple comorbidities, groups that may be more likely to benefit from completion of these studies,” they wrote. “Physician education and outreach will be an essential component to address these issues and to improve health care delivery to the most vulnerable populations."

What you can do

Given the disparities revealed by their study, Possin and Tsoy say it is important for individuals, family members and caregivers to be strong health care advocates.

"If you have concerns about changes in your or your loved one's memory or thinking skills, tell your primary care provider and advocate for a comprehensive evaluation,” they say. “A comprehensive evaluation should include a standardized cognitive test to objectively quantify the memory and other thinking changes, a clinical interview, and laboratory tests to evaluate for treatable causes. For many patients, brain imaging, such as CT or MRI scans, and a referral to a dementia specialist may be indicated."

What doctors should do

The researchers also note the important role of health care providers in working to limit disparities in dementia treatment based on race, ethnicity or socioeconomic factors.

"We recommend that primary care providers routinely ask all older patients about changes in memory and thinking skills, just as they would routinely check for other health factors like high blood pressure or hearing loss,” Possin and Tsoy say.

If a concern arises, they recommend primary care providers conduct a standardized cognitive assessment. The UCSF Memory and Aging Center has a “5-Step Brain Health Work-up” portal available to primary care providers. The researchers also suggest dementia specialists consider reaching out to underserved communities to reduce treatment inequities.

More research needed

In the editorial, Kawas and her colleagues point to the need for more diversity in dementia research — particularly as the aging U.S. population grows more diverse.

"Most of what we know today about risk and protective factors for dementia, treatment effects, and biomarkers related to cognitive impairment is derived from highly educated, urban dwelling, non-Hispanic white individuals,” they wrote. “Recruiting diverse populations into research requires directed resources to cultivate trust and engage with different communities. Importantly, physicians must be made aware of the disproportionate effect of dementia in underrepresented and diverse communities and fully recognize the biases of the medical establishment in the diagnosis and care of these underserved individuals.”

Peter Urban is a contributing writer and editor who focuses on health news. Urban spent two decades working as a correspondent in Washington, D.C., for daily newspapers in Connecticut, Massachusetts, Ohio, California and Arkansas, including a stint as Washington bureau chief for the Las Vegas Review-Journal. His freelance work has appeared in Scientific American, Bloomberg Government and CTNewsJunkie.com.