Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019;68(1):145-158.
doi: 10.3233/JAD-180992.

Neuropathological Diagnoses of Demented Hispanic, Black, and Non-Hispanic White Decedents Seen at an Alzheimer's Disease Center

Teresa Jenica Filshtein  1 , Brittany N Dugger  2 , Lee-Way Jin  2   3 , John M Olichney  4 , Sarah T Farias  4 , Luis Carvajal-Carmona  5 , Paul Lott  6 , Dan Mungas  4 , Bruce Reed  7 , Laurel A Beckett  8 , Charles DeCarli  4   9
Affiliations

Neuropathological Diagnoses of Demented Hispanic, Black, and Non-Hispanic White Decedents Seen at an Alzheimer's Disease Center

Teresa Jenica Filshtein et al. J Alzheimers Dis. 2019.

Abstract

Our nation is becoming increasingly diverse; however, few autopsy studies examine multiple ethnoracial groups, especially Hispanics. We examined differences in neuropathological diagnoses of 423 deceased participants with dementia from three ethnoracial groups (35 Black, 28 Hispanic, and 360 non-Hispanic White) evaluated at the University of California Davis Alzheimer's Disease Center. We used novel applications of bootstrap resampling and logistic regression standardization to project neuropathological diagnostic rates for non-Hispanic Whites to minority sample characteristics to improve inference of findings. Alzheimer's disease (AD) without significant cerebrovascular disease (CVD) or other dementia-related pathologies (AD (non-mixed)) was present in 15 Black (43%), 4 Hispanic (14%), and 156 (43%) non-Hispanic Whites. CVD sufficient to contribute to dementia was confirmed in 14 Black (40%), 15 Hispanic (54%), and 101 (28%) non-Hispanic White decedents. The observed CVD prevalence of 40% in Blacks exceeded the predicted 29% [95% CI: 22%-36%]. Despite being outside the 95% confidence interval, the difference between observed and predicted was not statistically significant after bootstrap testing. Conversely, for Hispanics, the observed proportion at 54% exceeded significantly the predicted prevalence of 24% from non-Hispanic Whites [95% CI: 16%-34%], avg. p = 0.008). An identical analysis using AD (non-mixed) as the outcome predicted AD (non-mixed) in Blacks averaging 41% [95% CI: 34%-48%], nearly equal to observed prevalence. For Hispanics, however, the observed proportion at 14%, was well below predictions (mean = 42%, 95% CI: 32%-53%], avg. p = 0.008). We conclude mixed diagnoses and CVD are more common in Hispanic and Black decedents than Non-Hispanic Whites with dementia in our cohort. The increased prevalence of vascular co-morbidity may be a potential opportunity to intervene more effectively in dementia treatment of those individuals.

Keywords: Alzheimer’s disease; autopsy; brain; cognitive aging; cohort studies; dementia; minority groups; neuropathology; vascular.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST/DISCLOSURE STATEMENT

With the exception of Drs. Charles DeCarli and Brittany Dugger, the authors have no conflict of interest to report. Dr. DeCarli is a consultant to Novartis. Dr. Dugger has received previous funding from Daiichi Sankyo unrelated to this project. This article was prepared while Dr. Reed was employed at U.C. Davis. The opinions expressed in this article are the author’s own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

Figures

Figure 1.
Figure 1.
Ethnoracial differences in mixed pathology. Pie chart shows proportions of individual and mixed pathologies in Non-Hispanic White, Black and Hispanic decedents with dementia.
Figure 2.
Figure 2.
Predicted prevalence of CVD (top) and AD (non-mixed) (bottom). Histograms representing the distribution of predicted prevalence of CVD (top) and AD (non-mixed) (bottom) for each ethnoracial group if their likelihood were identical to that based on a (resampled) similar group of non-Hispanic Whites decedents using predictor variables of age at death, gender, education, recruitment source and APOE genotype. Dotted vertical lines include 95% of bootstrap resamples, while solid vertical red line represents the observed prevalence.
See this image and copyright information in PMC

References

    1. Ortman JM, Velkoff VA, H H (2014) in Current Population Reports U.S. Census Bureau, Washington, D.C., pp. p25–1140.
    1. Alzheimer’s A (2016) 2016 Alzheimer’s disease facts and figures. Alzheimers Dement 12, 459–509. - PubMed
    1. Schneider JA, Arvanitakis Z, Bang W, Bennett DA (2007) Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 69, 2197–2204. - PubMed
    1. Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J (2006) Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol 5, 735–741. - PubMed
    1. Exalto LG, Quesenberry CP, Barnes D, Kivipelto M, Biessels GJ, Whitmer RA (2014) Midlife risk score for the prediction of dementia four decades later. Alzheimers Dement 10, 562–570. - PubMed

Publication types