Faster, Cheaper Tests for Alzheimer's May Improve Care for People of Color

 

Faster, Cheaper Tests for Alzheimer's May Improve Care for People of Color

A recent Mayo Clinic study conducted in Florida surveyed blood samples from 420 Black seniors, 151 of whom were already diagnosed with Alzheimer’s. They found six RNA molecules within their blood plasma that were associated with the disease and increased diagnosis accuracy for blood tests to 77% (). The goal for the Mayo Clinic study is to match the accuracy of blood tests to that of PET scans and spinal taps, which are the second most accurate way to diagnose Alzheimer’s (90%) after a postmortem brain scan (100%). Blood tests could offer a much cheaper and faster alternative to diagnosing Alzheimer’s.

According to Dr. Lisa Barnes’ article, “Alzheimer disease in African American individuals: increased incidence or not enough data?” (2021), older African American individuals are 2-3 times more likely to develop Alzheimer’s or cognitive impairment later in life compared to non-Latino white individuals. Barnes suggests three key challenges to understanding the racial disparities in diagnoses for African Americans: the objective diagnosis through neuropsychological tests, different findings depending on study designs, and an overall lack of data due to low study participation. The last challenge is heavily influenced by cultural factors and selection biases. For instance, most neuropathological studies enroll African Americans from a clinic setting, but African Americans are more likely to go to the hospital for behavioral or somatic problems (such as hallucinations or sleep disorders) than memory problems indicative of dementia. Both Barnes (2021) and Peters (2022) note this misconception of dementia as a normal sign of aging among some communities of color, which hinder individual’s access to early treatments that could help treat symptoms. Furthermore, unequal access to healthcare and insurance creates more challenges for some people of color, which is couple with a historical distrust of healthcare systems and research. Poverty and unemployment in historically segregated neighborhoods can also make it difficult for individuals to participate in healthy behaviors as simple as walking outside that can protect against cognitive decline.

The Mayo Clinic study addresses one issue with equity research by recruiting a sizable sample of Black patients, though the findings have implications for diagnosis in patients of all backgrounds. They chose this study population because of African American’s increased likelihood of developing Alzheimer’s disease. Jordan Lewis, an associate directory of the Memory Keepers Medical Discovery Team at the University of Minnesota, suggests that this increased likelihood stems from comorbidities such as chronic diabetes and high blood pressure (Peters, 2022). Barnes (2021) suggests that the likely cause of increased incidence among African Americans is a complex interaction of the biological factors accumulating throughout the life course (such as comorbidity) as well as socially patterned environmental exposures (such as poverty, segregation, etc.). Though the issue may be complex, evidence-informed solution strategies have been proposed.

If blood tests can match the accuracy of PET scans and spinal taps, they may indeed offer a cheaper alternative for those who cannot afford quality insurance. But other solutions which may be more encompassing, as proposed by Barnes, focus on the social and structural risk factors. First, Barnes (2022) emphasizes the need for diverse recruitment in research studies. Beyond that, recruitment efforts need to be culturally sensitive, and there needs to be a push for ongoing community-wide education to counteract the historic distrust of healthcare professionals and researchers. This distrust, which multiplied after the early 1970s with the Tuskegee Study, poses a barrier for the applicability of psychology research that primarily uses WEIRD populations (Western, Educated, Industrialized, Religious and Democratic). With Alzheimer’s research specifically, research professionals must encourage participants to consent to the invasive procedures typical of AD research, and this outreach must be based on mutual trust and benefit. On a larger scale, Barnes (2022) also notes that structural issues like poverty and unemployment are risk factors for communities of color when they make it difficult to participate in behaviors that have been shown to protect brain health later in life.

While the Mayo Clinic study signifies a promising shift in equitable treatment of Alzheimer’s due to the early diagnoses possible to more people with blood tests, the need for far-reaching societal and systematic change to address racial disparities in Alzheimer’s and many other mental diseases still exists.

References

Mayo Clinic study shows promise for detecting Alzheimer’s in blood. (2022). Retrieved 5 May 2022, from https://sahanjournal.com/health/mayo-clinic-study-alzheimers-disease-black-african-immigrants/

Barnes, L.L. (2021, December 6). Alzheimer disease in African American individuals: increased incidence or not enough data?. Nat Rev Neurol 18, 56–62 (2022). https://doi.org/10.1038/s41582-021-00589-3