Symposium Highlights Research, Care Disparities Among Latinos
Improved access to high-quality healthcare and research for Latinos living with Alzheimer’s disease and related dementia are needed, according to a summary report from the second Latinos & Alzheimer’s Symposium.
Understanding underlying disease-related processes unique to Latino populations, and identifying social and environmental risk factors for this group also are required, the researchers noted.
“By elucidating the complex picture of [Alzheimer’s disease] and sociocultural characteristics of diverse Latinos, and by fostering the growth of Latino scientific and healthcare personnel as well as Latino participation in AD research and clinical trials, research will fill critical knowledge gaps for an increasingly important segment of the older population,” they wrote.
The report, “Addressing the disparities in dementia risk, early detection and care in Latino populations: Highlights from the second Latinos & Alzheimer’s Symposium,” was published in Alzheimer’s & Dementia.
Developing research and care methods that are culturally and linguistically inclusive are also needed, the researchers said.
Alzheimer’s disease is expected to impact Latinos — people whose country of origin or ancestry is from Latin America — more than any other ethnic group in the U.S. Statistics show that Latinos of Mexican descent are the largest group in the U.S., followed by Puerto Ricans, Central Americans, South Americans, and Cubans.
The Alzheimer’s Association hosted the second Latinos & Alzheimer’s Symposium in May last year, giving researchers from the U.S. and Latin American countries the opportunity to highlight current Alzheimer’s-related research among Latinos. This newly released report describes an overview of the symposium.
The prevalence of Alzheimer’s disease and related dementia among Latino populations varies widely in the U.S., with those of Caribbean descent (Dominican and Puerto Rican) being thought to have the highest rates and people with a Mexican and Central American background having the lowest rates. However, these estimates are more than 20 years old, underscoring the need to update prevalence data to identify current trends in risks and caregiving.
Studies indicate that vascular risk factors, such as high blood pressure and diabetes, are predominant in Latinos with dementia. This suggests that improving vascular health for middle-aged adults may reduce the risk of dementia later in life.
Other identified risk factors include education levels, cultural assimilation (acculturation), socioeconomic conditions, immigration, language abilities, and bilingualism.
Because language can shape cognitive function, bilingualism may play a role in protecting against dementia later in life. Bilingualism also may impact cognitive tests. Thus, a bilingual background needs to be considered to obtain accurate performance measures.
In addition, commonly used psychological tests may not be sensitive to changes in cognition in Latinos in the U.S., who speak Spanish as their first language. Cultural factors also have been shown to influence cognitive tasks. “Thus, cultural and linguistic factors, as well as other sociodemographic factors, need to be considered when examining cognitive performance,” the researchers wrote.
People who survived COVID-19 have different levels of Alzheimer’s-related biomarkers than people who have not been exposed to the virus. Latinos in the U.S. have experienced a higher burden of COVID-19, hospitalization, and mortality than other ethnic groups. Moreover, emerging evidence shows COVID-19 survivors can undergo memory loss and prolonged neurological symptoms.
Profiles of proteins in the bloodstream show different patterns in Mexican Americans, with metabolism-related biomarkers predominating in mild cognitive impairment shifting to inflammation-related markers in dementia. The opposite relationship has been seen in non-Hispanic whites.
Further, preliminary imaging data suggest that amyloid deposits in the brain, an underlying cause of Alzheimer’s, occur at a lower rate in Mexican Americans than in non-Hispanic whites, despite an earlier age of cognitive decline onset.
The authors suggest that studies investigate Alzheimer’s-related biomarkers in Latinos as well as vascular disease’s contribution to cognitive impairment and dementia.
Studies also should focus on sociocultural factors such as cultural assimilation and education, develop more culturally-appropriate cognitive tests, and explore the unique genomic ancestry of diverse Latinos to gain insight into Latino health, cognitive aging, and impairment.
“Importantly, increased engagement with Latino communities is essential for successfully recruiting diverse and representative Latinos into cognitive aging and dementia research,” the scientists wrote, adding that because Latinos comprise less than 1% of clinical trial participants, researchers must adjust their recruitment strategies to obtain numbers sufficient to conduct well-powered studies on Latinos.
This applies to trials testing pharmaceuticals and lifestyle interventions, as well as genetic studies of rare, inherited variants associated with Alzheimer’s.
Latino investigators in the medical workforce represent another institution-level barrier to inclusive research. A more diverse scientific workforce may better understand the Latino community’s specific needs, foster long-term relationships between communities and academic centers, and partner with established disease support associations.
Latinos face many barriers in getting access to healthcare services for Alzheimer’s-related dementia, which are worsened by a lack of awareness about the condition. According to the behavioral risk factor surveillance system (BRFSS), 44% of Hispanics with self-reported cognitive decline would discuss their symptoms with a healthcare professional, and 39% of those with cognitive decline have had issues accessing healthcare.
The most common barriers to access include a lack of health insurance, cost concerns, transportation, and long wait times. Latinos also have misconceptions about dementia, with many believing it is a preliminary stage of Alzheimer’s and that the disease is the stage when a person’s memory is lost. Generally, most Latinos don’t know what treatments or services are available or have had problems navigating the healthcare system and finding resources in their language.
Many Latinos believe Alzheimer’s is a normal part of aging, that they will not live long enough to develop the condition, or may be insulted if a healthcare provider recommends cognitive testing.
This suggests concerted outreach efforts are needed, including high-tech options such as messaging apps, or low-tech methods such as placing flyers in restaurants that Latinos frequent. Churches, Hispanic chambers of commerce, or the National Hispanic Council on Aging, which enlists local health workers to increase health literacy in Latino communities, also could be used for messaging.
The symposium featured mentoring sessions on career paths and allowed attendees to engage with leading investigators in the field to build a medical and research workforce to represent Latino communities. Topics included community engagement, epidemiology, public health, clinical practice and research, the interplay between academia and industry, and careers in Alzheimer’s research.
“Special attention needs to be given to many factors, including the heterogeneity within Latino populations, not only with respect to their country of origin, but also education, genetic ancestry, socioeconomic factors, years of acculturation, migration history, and perceptions of AD and dementia,” the authors concluded.