Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review. Possible Reasons for Racial and Ethnic Disparities


Possible reasons for racial and ethnic disparities include factors related to measurement of Alzheimer's disease, genetics, cardiovascular and cerebrovascular disease, socioeconomic factors, cultural differences, and racial and ethnic discrimination. A range of pathways have been suggested that link race and ethnicity with cognitive impairment, some of which have implications for disparities (Figure 3) (Glymour & Manley, 2008). In this section, we describe the evidence underlying selected factors, mediators, and pathways associated with disparities in this population.

FIGURE 3. Pathways Linking Race/Ethnicity and Cognitive Impairment

FIGURE 3, Direction Chart: Three Mediators--Distal, Socially Patterned; Individual; Proximal. Race/Ethnicity leads to (1) Geographic exposures, Immigration, Socioeconomic status, Discrimination, Group resources/ties/identify. (1) leads to (2) Material conditions, Psychological stressors; (3) Cognitive engagement; (4) Test-taking skills. (2) leads to (5) Physical health, Health behaviors. (3) leads to (5) and (6) Cognition function/impairment/change. (4) leads to (7) Diagnosis of cognitive impairment. (5) leads to (6). (6) leads to (7). (8) Access to medical care leads to (6) and (7).

SOURCE: Adapted from Glymour and Manly, 2008.

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