University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Alzheimer Dis Assoc Disord. 2011 Jul-Sep;25(3):187-95. doi: 10.1097/WAD.0b013e318211c6c9.
Debate exists regarding differences in the prevalence of Alzheimer disease (AD) in African Americans and Hispanics in the United States, with some evidence suggesting that the prevalence of AD may be considerably higher in these groups than in non-Hispanic whites. Despite this possible disparity, patients of minority ethnoracial groups often receive delayed diagnosis or inadequate treatment for dementia. This review investigates these disparities by conceptualizing the dementia disease process as a product of both biological and cultural factors. Ethnoracial differences in biological risk factors, such as genetics and cardiovascular disease, may help to explain disparities in the incidence and prevalence of AD, whereas race-specific cultural factors may impact diagnosis and treatment. Cultural factors include differences in perceptions about what is normal aging and what is not, lack of adequate access to medical care, and issues of trust between minority groups and the medical establishment. The diagnosis of AD in diverse populations may also be complicated by racial biases inherent in cognitive screening tools widely used by clinicians, but controlling for literacy level or using savings scores in psychometric analyses has the potential to mitigate these biases. We also suggest that emerging biomarker-based diagnostic tools may be useful in further characterizing diverse populations with AD. Recognizing the gap in communication that exists between minority communities and the medical research community, we propose that education and outreach are a critical next step in the effort to understand AD as it relates to diverse populations.
关于美国非裔美国人和西班牙裔人群中阿尔茨海默病（AD）患病率的差异存在争议，有一些证据表明，这些人群中 AD 的患病率可能比非西班牙裔白人高得多。尽管存在这种可能的差异，但少数族裔患者群体经常因痴呆症而延迟诊断或治疗不足。本综述通过将痴呆症的发病过程概念化为生物和文化因素的共同产物，探讨了这些差异。生物风险因素（如遗传和心血管疾病）方面的种族差异可能有助于解释 AD 的发病率和患病率的差异，而特定种族的文化因素可能会影响诊断和治疗。文化因素包括对正常衰老和非正常衰老的看法、缺乏充分的医疗保健机会以及少数群体与医疗机构之间的信任问题等方面的差异。在不同人群中诊断 AD 可能还会受到临床医生广泛使用的认知筛查工具中固有的种族偏见的影响，但控制文化程度或在心理计量分析中使用节省分数有潜力减轻这些偏见。我们还认为，新兴的基于生物标志物的诊断工具可能有助于进一步描述 AD 不同人群的特征。鉴于少数族裔社区与医学研究界之间存在沟通差距，我们建议教育和外展是了解与不同人群相关的 AD 的关键下一步。
