Continuum (Minneap Minn). 2022 Jun 1;28(3):872-884. doi: 10.1212/CON.0000000000001088.
Causes of health disparities in Alzheimer disease and related dementias (ADRD) in the United States are multifactorial. This article contextualizes health disparities as they relate to the neurodegenerative processes of ADRD.
Older adults' life expectancy has increased such that a 65-year-old is expected to live 19 or more years and an 85-year-old can expect to live, on average, 6 to 7 years longer. Individuals of certain ethnoracial groups (Black, Hispanic/Latino, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) may be at a higher risk of incident ADRD compared to non-Hispanic/Latino White people. These differences in a higher risk of ADRD across ethnoracial groups persist despite no statistically significant differences in the rate of cognitive decline over time. The intersectionality of social determinants of health, experiences with discrimination and oppression, and access to care are related to the issue of justice and the risk for and expression of ADRD. The theoretical frameworks of various health disparities provide organized approaches to tracking the progression of health disparities for diverse patients.
ADRD health disparities are complex. Neurologists and their care teams must consider the main reasons for clinical ADRD evaluations of members of ethnoracial groups and the factors that may impact patient adherence and compliance with diagnostic and management recommendations.
美国阿尔茨海默病和相关痴呆症（ADRD）患者健康差异的原因是多方面的。本文将健康差异与 ADRD 的神经退行性过程联系起来。
美国老年人的预期寿命有所增加，65 岁的人预计还能再活 19 年以上，85 岁的人平均还能再活 6 到 7 年。某些族裔群体（黑人、西班牙裔/拉丁裔、美国印第安人/阿拉斯加原住民和夏威夷原住民/太平洋岛民）的个体患 ADRD 的风险可能高于非西班牙裔/拉丁裔白人。尽管随着时间的推移，认知能力下降的速度没有统计学上的显著差异，但不同族裔群体之间 ADRD 风险更高的这种差异仍然存在。健康决定因素、歧视和压迫经历以及获得医疗保健机会的社会决定因素的交叉性与正义问题以及 ADRD 的风险和表现有关。各种健康差异的理论框架为跟踪不同患者的健康差异进展提供了有条理的方法。
ADRD 健康差异是复杂的。神经科医生及其护理团队必须考虑到对不同族裔群体成员进行 ADRD 临床评估的主要原因，以及可能影响患者对诊断和管理建议的依从性和遵守性的因素。
