Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan
Abstract
Objective: To compare the incidence rates for AD among elderly African-American, Caribbean Hispanic, and white individuals and to determine whether coincident cerebrovascular disease contributes to the inconsistency in reported differences among ethnic groups.
Methods: This was a population-based, longitudinal study over a 7-year period in the Washington Heights and Inwood communities of New York City. Annual incidence rates for AD were calculated and compared by ethnic group, and cumulative incidence adjusted for differences in education, diabetes, cardiovascular risk factors, and stroke was calculated.
Results: The age-specific incidence rate for probable and possible AD was 1.3% (95% CI, 0.8 to 1.7) per person-year between the ages of 65 and 74 years, 4.0% (95% CI, 3.2 to 4.8) per person-year between ages 75 and 84 years, and 7.9% (95% CI, 5.5 to 10.5) per person-year for ages 85 and older. Compared to white individuals, the cumulative incidence of AD to age 90 years was increased twofold among African-American and Caribbean Hispanic individuals. Adjustment for differences in number of years of education, illiteracy, or a history of stroke, hypertension, heart disease, or diabetes did not change the disproportionate risks among the three ethnic groups.
Conclusion: The incidence rate for AD was significantly higher among African-American and Caribbean Hispanic elderly individuals compared white individuals. The presence of clinically apparent cardiovascular or cerebrovascular disease did not contribute to the increased risk of disease. Because the proportion of African-American and Caribbean Hispanic individuals reaching ages 65 and older in the United States is increasing more rapidly than the proportion of white individuals, it is imperative that this disparity in health among the elderly be understood.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Bachman DL, Wolf PA, Linn R, et al. Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham Study. Neurology . 1992; 42: 115–119.
2.
Bachman DL, Wolf PA, Linn RT, et al. Incidence of dementia and probable Alzheimer’s disease in a general population: the Framingham Study. Neurology . 1993; 43: 515–519.
3.
Breteler MM, Claus JJ, van Duijn CM, Launer LJ, Hofman A. Epidemiology of Alzheimer’s disease. Epidemiol Rev . 1992; 14: 59–82.
4.
Evans DA, Funkenstein HH, Albert MS, et al. Prevalence of Alzheimer’s disease in a community population of older persons. Higher than previously reported [see comments]. JAMA. 1989; 262: 2551–2556.
5.
Fillenbaum GG, Heyman A, Huber MS, et al. The prevalence and 3-year incidence of dementia in older Black and White community residents. J Clin Epidemiol . 1998; 51: 587–595.
6.
Folstein MF, Bassett SS, Anthony JC, Romanoski AJ, Nestadt GR. Dementia: case ascertainment in a community survey. J Gerontol . 1991; 46: M132–M138.
7.
Fratiglioni L, De Ronchi D, Aguero–Torres H. Worldwide prevalence and incidence of dementia. Drugs Aging . 1999; 15: 365–375.
8.
Gurland BJ, Wilder DE, Lantigua R, et al. Rates of dementia in three ethnoracial groups. Int J Geriatr Psychiatry . 1999; 14: 481–493.
9.
Hebert LE, Scherr PA, Beckett LA, et al. Age-specific incidence of Alzheimer’s disease in a community population. JAMA . 1995; 273: 1354–1359.
10.
Hendrie HC, Hall KS, Pillay N, et al. Alzheimer’s disease is rare in Cree. Int Psychogeriatr . 1993; 5: 5–14.
11.
Hendrie HC, Osuntokun BO, Hall KS, et al. Prevalence of Alzheimer’s disease and dementia in two communities: Nigerian Africans and African Americans [see comments]. Am J Psychiatry . 1995; 152: 1485–1492.
12.
Heyman A, Fillenbaum G, Prosnitz B, Raiford K, Burchett B, Clark C. Estimated prevalence of dementia among elderly black and white community residents. Arch Neurol . 1991; 48: 594–598.
13.
Jorm AF, Jolley D. The incidence of dementia: a meta-analysis. Neurology . 1998; 51: 728–733.
14.
Launer LJ, Andersen K, Dewey ME, et al. Rates and risk factors for dementia and Alzheimer’s disease: results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups European Studies of Dementia. Neurology . 1999; 52: 78–84.
15.
Ott A, Breteler MM, van Harskamp F, Stijnen T, Hofman A. Incidence and risk of dementia. The Rotterdam Study. Am J Epidemiol . 1998; 147: 574–580.
16.
Perkins P, Annegers JF, Doody RS, Cooke N, Aday L, Vernon SW. Incidence and prevalence of dementia in a multiethnic cohort of municipal retirees. Neurology . 1997; 49: 44–50.
17.
Rocca WA, Cha RH, Waring SC, Kokmen E. Incidence of dementia and Alzheimer’s disease: a reanalysis of data from Rochester, Minnesota, 1975–1984. Am J Epidemiol . 1998; 148: 51–62.
18.
White L, Petrovitch H, Ross GW, et al. Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia Aging Study [see comments]. JAMA . 1996; 276: 955–960.
19.
Zhang M, Katzman R, Yu E, Liu W, Xiao SF, Yan H. A preliminary analysis of incidence of dementia in Shanghai, China. Psychiatry Clin Neurosci . 1998; 52 (suppl): S291–S294.
20.
von Strauss E, Viitanen M, De Ronchi D, Winblad B, Fratiglioni L. Aging and the occurrence of dementia: findings from a population-based cohort with a large sample of nonagenarians. Arch Neurol . 1999; 56: 587–592.
21.
Andersen K, Launer LJ, Dewey ME, et al. Gender differences in the incidence of AD and vascular dementia: the EURODEM Studies. EURODEM Incidence Research Group. Neurology . 1999; 53: 1992–1997.
22.
Gao S, Hendrie HC, Hall KS, Hui S. The relationships between age, sex, and the incidence of dementia and Alzheimer disease: a meta-analysis. Arch Gen Psychiatry . 1998; 55: 809–815.
23.
Letenneur L, Gilleron V, Commenges D, Helmer C, Orgogozo JM, Dartigues JF. Are sex and educational level independent predictors of dementia and Alzheimer’s disease? Incidence data from the PAQUID project. J Neurol Neurosurg Psychiatry . 1999; 66: 177–183.
24.
Miller FD, Hicks SP, D’Amato CJ, Landis JR. A descriptive study of neuritic plaques and neurofibrillary tangles in an autopsy population. Am J Epidemiol . 1984; 120: 331–341.
25.
de la Monte SM, Hutchins GM, Moore GW. Racial differences in the etiology of dementia and frequency of Alzheimer lesions in the brain. J Natl Med Assoc . 1989; 81: 644–652.
26.
Hobbs FB, Damon BL. 65+ in the United States. Washington, DC: US Department of Commerce, 1993.
27.
Gurland B, Golden RR, Teresi JA, Challop J. The SHORT-CARE: an efficient instrument for the assessment of depression, dementia and disability. J Gerontol . 1984; 39: 166–169.
28.
Pittman J, Andrews H, Tatemichi T, et al. Diagnosis of dementia in a heterogeneous population. A comparison of paradigm-based diagnosis and physician’s diagnosis. Arch Neurol . 1992; 49: 461–467.
29.
Stern Y, Andrews H, Pittman J, et al. Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education. Arch Neurol . 1992; 49: 453–460.
30.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res . 1975; 12: 189–198.
31.
Kaplan E, Goodglass H, Weintraub S. Boston Naming Test. Philadelphia, PA: Lea and Febiger, 1983.
32.
Benton A. FAS Test. In: Spreen O, Benton A, eds. Neurosensory Center Comprehensive Examination for Aphasia. Victoria, Canada: University of Victoria, 1967.
33.
Goodglass H, Kaplan E. Assessment of aphasia and related disorders. Philadelphia, PA: Lea and Febiger, 1983.
34.
Wechsler D. WAIS-R Manual. New York, NY: The Psychological Corporation, 1981.
35.
Mattis S. Mental status examination for organic mental syndrome in the elderly patient. New York, NY: Grune and Stratton, 1976.
36.
Rosen WG. The Rosen Drawing Test. Odessa, FL: Psychological Assessment Resources Inc, 1981.
37.
Benton AL. The Benton Visual Retention Test. New York, NY: The Psychological Corporation, 1955.
38.
Buschke H, Fuld PA. Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology . 1974; 24: 1019–1025.
39.
Schofield PW, Tang M, Marder K, et al. Consistency of clinical diagnosis in a community-based longitudinal study of dementia and Alzheimer’s disease. Neurology . 1995; 45: 2159–2164.
40.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology . 1984; 34: 939–944.
41.
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop [see comments]. Neurology . 1993; 43: 250–260.
42.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry . 1982; 140: 566–572.
43.
Stricks L, Pittman J, Jacobs DM, Sano M, Stern Y. Normative data for a brief neuropsychological battery administered to English- and Spanish-speaking community-dwelling elders. J Int Neuropsychol Soc . 1998; 4: 311–318.
44.
Rothman KJ, Greenland S. Modern epidemiology. Philadelphia, PA: Lippincott Willams & Wilkins, 1998.
45.
Klein JP, Moeschberger ML. Survival analysis: techniques for censored and truncated data. New York, NY: Springer– Verlag, 1999.
46.
Korn EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale [see comments]. Am J Epidemiol . 1997; 145: 72–80.
47.
Grambsch PM, Therneau TM, Fleming TR. Diagnostic plots to reveal functional form for covariates in multiplicative intensity models. Biometrics . 1995; 51: 1469–1482.
48.
Moroney JT, Tang MX, Berglund L, et al. Low-density lipoprotein cholesterol and the risk of dementia with stroke. JAMA . 1999; 282: 254–260.
49.
Harrell LE, Callaway R, Powers R. Autopsy in dementing illness: who participates? Alzheimer Dis Assoc Disord . 1993; 7: 80–87.
50.
Massoud F, Devi G, Stern Y, et al. A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia. Arch Neurol . 1999; 56: 1368–1373.
51.
Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer’s disease [see comments]. JAMA . 1994; 271: 1004–1010.
52.
Callahan CM, Hall KS, Hui SL, Musick BS, Unverzagt FW, Hendrie HC. Relationship of age, education, and occupation with dementia among a community-based sample of African Americans. Arch Neurol . 1996; 53: 134–140.
53.
Geerlings MI, Schmand B, Jonker C, Lindeboom J, Bouter LM. Education and incident Alzheimer’s disease: a biased association due to selective attrition and use of a two-step diagnostic procedure? Int J Epidemiol . 1999; 28: 492–497.
54.
Hall KS, Gao S, Unverzagt FW, Hendrie HC. Low education and childhood rural residence: risk for Alzheimer’s disease in African Americans. Neurology . 2000; 54: 95–99.
55.
Liu HC, Chou P, Lin KN, et al. Assessing cognitive abilities and dementia in a predominantly illiterate population of older individuals in Kinmen. Psychol Med . 1994; 24: 763–770.
56.
Teresi JA, Golden RR, Cross P, Gurland B, Kleinman M, Wilder D. Item bias in cognitive screening measures: comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups. J Clin Epidemiol . 1995; 48: 473–483.
57.
Unverzagt FW, Hui SL, Farlow MR, Hall KS, Hendrie HC. Cognitive decline and education in mild dementia. Neurology . 1998; 50: 181–185.
58.
Manly JJ, Jacobs DM, Sano M, et al. Effect of literacy on neuropsychological test performance in nondemented, education-matched elders. J Int Neuropsychol Soc . 1999; 5: 191–202.
59.
Chartier–Harlin MC, Parfitt M, Legrain S, et al. Apolipoprotein E, epsilon 4 allele as a major risk factor for sporadic early and late-onset forms of Alzheimer’s disease: analysis of the 19q13.2 chromosomal region. Hum Mol Genet . 1994; 3: 569–574.
60.
Farrer LA, Cupples LA, Haines JL, et al. Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium [see comments]. JAMA . 1997; 278: 1349–1356.
61.
Tang MX, Maestre G, Tsai WY, et al. Relative risk of Alzheimer disease and age-at-onset distributions, based on APOE genotypes among elderly African Americans, Caucasians, and Hispanics in New York City. Am J Hum Genet . 1996; 58: 574–584.
62.
Tang MX, Stern Y, Marder K, et al. The APOE-epsilon4 allele and the risk of Alzheimer disease among African Americans, whites, and Hispanics [see comments]. JAMA . 1998; 279: 751–755.
63.
Romas SN, Mayeux R, Rabinowitz D, et al. The deletion polymorphism and Val1000Ile in alpha-2-macroglobulin and Alzheimer disease in Caribbean Hispanics. Neurosci Lett . 2000; 279: 133–136.
64.
Tycko B, Feng L, Nguyen L, et al. Polymorphisms in the human apolipoprotein-J/clusterin gene: ethnic variation and distribution in Alzheimer’s disease [published erratum appears in Hum Genet 1998;102:496]. Hum Genet . 1996; 98: 430–436.
65.
Osborne LC, Mason JM. HLA-A/B haplotye frequencies among US Hispanic and African-American populations. Hum Genet . 1993; 91: 326–332.
66.
Fraser PA, Yunis EJ, Alper CA. Excess admixture proportion of extended major histocompatability complex haplotypes of Caucasian origin among rheumatoid arthritis associated haplotypes in African Americans and Afro-Caribbeans. Ethn Health . 1996; 1: 153–159.
67.
Day JC. Population projections of the United States by age, sex, race, and Hispanic origin: 1995 to 2050. Washington, DC: US Bureau of the Census, Current Population Reports 1996;25–1130.
Information & Authors
Information
Published In
Copyright
© 2001.
Publication History
Received: July 17, 2000
Accepted: October 10, 2000
Published online: January 9, 2001
Published in print: January 9, 2001
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Psychological and neurobiological mechanisms involved in the relationship between loneliness and cognitive decline in older adults, Brain, Behavior, and Immunity, 116, (10-21), (2024).https://doi.org/10.1016/j.bbi.2023.11.034
- Unravelling the Threads: A Brief Insight into Vascular Dementia, Journal of Vascular Diseases, 2, 4, (419-437), (2023).https://doi.org/10.3390/jvd2040033
- Genetics of Alzheimer’s Disease in the African American Population, Journal of Clinical Medicine, 12, 16, (5189), (2023).https://doi.org/10.3390/jcm12165189
- Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in African Americans: Focus on Caregivers, Healthcare, 11, 6, (868), (2023).https://doi.org/10.3390/healthcare11060868
- Identifying Probable Dementia in Undiagnosed Black and White Americans Using Machine Learning in Veterans Health Administration Electronic Health Records, Big Data and Cognitive Computing, 7, 4, (167), (2023).https://doi.org/10.3390/bdcc7040167
- The Black radical imagination: a space of hope and possible futures, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1241922
- Core issues, case studies, and the need for expanded Legacy African American genomics, Frontiers in Genetics, 14, (2023).https://doi.org/10.3389/fgene.2023.843209
- Reliability and Validity of Self-Reported Vascular Risk Factors: Hypertension, Diabetes, and Heart Disease, in a Multi-Ethnic Community Based Study of Aging and Dementia, Journal of Alzheimer's Disease, 95, 1, (275-285), (2023).https://doi.org/10.3233/JAD-230374
- Validation of a Multivariate Prediction Model of the Clinical Progression of Alzheimer’s Disease in a Community-Dwelling Multiethnic Cohort, Journal of Alzheimer's Disease, 95, 1, (93-117), (2023).https://doi.org/10.3233/JAD-220811
- Community-Led, Cross-Sector Partnership of Housing and Health Care to Promote Aging in Place (Unite Health Project): Protocol for a Prospective Observational Study, JMIR Research Protocols, 12, (e47855), (2023).https://doi.org/10.2196/47855
- See more
Loading...
View Options
Get Access
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
Purchase this article to get full access to it.