Alzheimer's Detection Low Among Blacks, Hispanics
MICHEL MARTIN, host:
And now it's time to go behind close doors. That's the part of the program where we talk about matters that people often find difficult to discuss. We want to talk about Alzheimer's disease now, because more than five million people are living with Alzheimer's disease and other memory-robbing diseases. It's the seventh leading cause of death in the U.S. And, according to a new report from the Alzheimer's Association, African-Americans and Hispanics are far more likely to develop the illness than whites but less likely to be diagnosed, particularly early on when medicine and treatment can have a direct impact on how they live with the disease.
We thought we would talk more about Alzheimer's and race so we contacted Maria Carrillo, The Alzheimer's Association's senior director of medical and scientific relations. She holds a doctorate from Northwestern University's Institute for Neuroscience and she's with us now.
Welcome. Maria Carrillo, thanks for joining us.
Dr. MARIA CARRILLO (Senior Director, Medical and Scientific Relations, Alzheimer's Association): Thank you for having me.
MARTIN: I want to ask you to make this really simple for us, if you would. What is Alzheimer's and is it the same as dementia?
Dr. CARRILLO: Actually, dementia I would like at as an umbrella term. So when you talk about dementia it's really an overarching term like cancer. Your next step would be to say, what kind? Alzheimer's disease happens to be the most largely represented dementia.
MARTIN: What circumstances exist that should cause someone, be it a spouse, be it a patient himself or herself, be it a caregiver, to start thinking about an Alzheimer's diagnosis? What are some of the things that someone should look for?
Dr. CARRILLO: There are some suggestions that we would give. You know, everybody forgets, you know, keys and wallets but most people can say okay, where was I? I was getting out of the car then I did this. Then I picked up the grocery bag. You know, an inability to actually retrace your steps or recreate what youve done would be one of the signs of concern.
Another is inability to remember very common words. When youre saying, you know, I want to go and use that thing that I used to brush my hair. You know, you can't remember the names of a comb. You can't remember certain everyday words. Something else that is of concern is when you are very familiar with a location and perhaps, youre not so good at getting there and getting back. You experience some disorientation, getting lost, not recognizing familiar locations. Those are some things that are of concern that we really encourage people to seek the help of their physician, perhaps even get referrals to a neurologist.
MARTIN: So let's focus on the main reason we called you today, which is this very striking ethnic difference in the prevalence of Alzheimer's disease among different populations. And you note in you your report that African-Americans are twice as likely to have Alzheimer's than whites, and Hispanics are about one and a half times more likely. Why would that be?
Dr. CARRILLO: We tried to see if perhaps genetics was a component and, you know, it doesnt seem to be linked to any very specific genetic code. So what we then looked for were the reasons why perhaps people of African-American descent, Hispanic-American descent had these types of diagnostics. We found very clearly that African-Americans are more prone to high blood pressure and diabetes, almost at twice the risk in comparisons to white Americans. Hispanic-Americans are almost twice as likely to have diabetes. So between those two factors, which we know for a fact are big risk factors for Alzheimer's disease, we came to the conclusion that really these numbers were driven by high blood pressure and diabetes as risk factors.
MARTIN: Why might that be, any idea? Or we just dont know yet?
Dr. CARRILLO: You know, there's lots of hints in the literature that cardiovascular risk factors are huge contributors to Alzheimer's disease risk because of the mechanism through which your cardiovascular system cleans out your system in general but increasingly, your brain. So there are lots of hints in the science that your brain has excess of proteins that are just not very good for it. And that perhaps a compromised cardiovascular system - for any reason that might be compromised - really dont allow the clearance of those proteins as they should, and over a long period of time, they tend to build up in the brain.
MARTIN: So what should people know about this, particularly people who are caring for elderly family members or family members who might be at risk? Is there something that caregivers who work with these populations should be especially attentive to?
Dr. CARRILLO: Sure. So I think there are two things that really came out of our report. The first is that they're about 11 million caregivers in the United States caring for someone with Alzheimer's disease and they contribute about 12.5 billion hours towards this. Their level of stress is so high, much higher than it would be if they were caring for someone in another type of disease.
The other thing that our facts and figures report for 2010 really highlights is that it is really actually good news that we found that the risk factors were diabetes and high blood pressure. Those are actually modifiable risk factors. Its really important for the community at large, especially the African-American and the Hispanic-American community to note that those are modifiable with changes in your midlife, and even later in life changes can still have positive effects that can even delay cognitive decline.
MARTIN: This may come out of left field for you, but one of things that I was interested in is there's a lot of talk about racial profiling. Sometimes people are very hesitant to raise ethic differences or racial differences because they fear that it will lead to stereotypes and assumptions that they dont want to deal with.
On the other hand, youre saying in this area it is important to know. I'm just wondering how should people navigate this when they hear this. Because I can just imagine there are some people who will hear this and think, oh great, just something else African-Americans and Latinos are being stigmatized around, that they're more likely to get Alzheimer's. Have you thought about this in the course of your work? And I'm wondering how would you recommend that people think about ethnic and racial difference when it comes to health.
Dr. CARRILLO: Well, Michel, we gave this a lot of thought. We thought it was still very important to focus on it despite the fact that some people might put a negative spin on the report finding. The importance is that the factors are in fact modifiable and that it is quite clearly acknowledged that some populations are more prone to certain diseases. So we felt that the generalizability(ph) of the message was still so important.
Secondly, we also know populations of color in the United States are growing rapidly and they're growing more rapidly than the white American population. That really was an impactful part of the decision of the Alzheimer's Association to focus on these two populations.
MARTIN: You think it just can't be ignored.
Dr. CARRILLO: I feel that it certainly doesnt. And I also, as a Mexican-American myself, felt that it was very important for the community at large to be aware that diseases that you live with today can really impact your cognition in the future, and that managing those are critical.
MARTIN: And finally, before I let you go, can I just ask how you got interested in this area?
Dr. CARRILLO: Certainly. I have been in the area of neuroscience since undergraduate and I've been interested in it because I felt that we know so much about so many diseases, but I feel like the brain gives us a particular challenge. Its a closed system and I think ever since college, I thought, you know, we can't get in there and just take a look at it. We can't biopsy it. We dont know so much about it. Then once you start learning about the brain and about how you learn new things and how you memorize, you start thinking about ways in which those things - learning and memory - go wrong. And that's how I started getting interested in Alzheimer's disease.
MARTIN: Maria Carrillo is the Alzheimer's Association's senior director of medical and scientific relations and she joined us from Chicago. You can read the report that weve been talking about, the 2010 Alzheimer's Disease Facts and Figures" at our Web site. We'll have a link if you go to NPR.org. Go to the programs page. Just click on TELL ME MORE.
MARTIN: Maria Carrillo, thank you so much for speaking with us.
Dr. CARRILLO: Thanks for having me. Thank you.