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Minorities Receive Less Timely Dementia Diagnoses Than Whites

Study of Medicare recipients finds racial and ethnic disparities

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Blacks, Hispanics and Asians are less likely to receive a timely diagnosis of early dementia than whites, according to a study of California Medicare claims.

"Our findings highlight substantial gaps in diagnostic care among racially diverse older adults that are likely associated with underrepresentation in clinical trials and inequities in treatment,” the researchers wrote in a study published in JAMA Neurology. “Major policy and practice efforts are necessary to address these gaps via targeted interventions for vulnerable populations.”

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Researchers analyzed claims filed by 10,472 Medicare fee-for-service beneficiaries who received a diagnosis of either incident mild cognitive impairment (MCI) or dementia in the first six months of 2015 in California. While 23.3 percent of white beneficiaries received a first diagnosis of MCI, that was true of just 12.3 percent of Asians, 15.8 percent of Hispanics and 18.2 percent of Blacks.

They also found that Asians were significantly less likely to receive as comprehensive a diagnostic screening as whites, for example, with only 28.8 percent of Asians receiving a specialist evaluation compared to 35.4 percent of whites.

Early intervention important

Two of the study researchers, Katherine Possin, an associate professor of neurology at the Global Brain Health Institute at the University of California San Francisco (UCSF), and Elena Tsoy, a postdoctoral fellow in neuropsychology at UCSF's Memory and Aging Center, explained via email the importance of early intervention when it comes to brain health.

"When dementia diagnosis is delayed, there are missed opportunities for good care. This includes the identification of reversible causes, timely treatment of cognitive symptoms, and supportive care for families. With new treatments for Alzheimer's disease and other dementias on the horizon, these delays in diagnosis — if left unaddressed — will further deepen inequities in treatment,” they said.

An accompanying editorial in JAMA Neurology noted that the study apparently is the first to focus on disparities related to “time to diagnosis and comprehensiveness of evaluation” of dementia. Claudia Kawas, M.D., a geriatric neurologist and researcher at the University of California, Irvine, and other authors of the editorial noted that they were surprised to find that despite having Medicare insurance, most beneficiaries did not receive a comprehensive “workup” including neuroimaging, laboratory blood assays and specialty referrals for their MCI or dementia diagnoses.

"The absence of workup was particularly true for those who were older and had multiple comorbidities, groups that may be more likely to benefit from completion of these studies,” they wrote. “Physician education and outreach will be an essential component to address these issues and to improve health care delivery to the most vulnerable populations."

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What you can do

Given the disparities revealed by their study, Possin and Tsoy say it is important for individuals, family members and caregivers to be strong health care advocates.

"If you have concerns about changes in your or your loved one's memory or thinking skills, tell your primary care provider and advocate for a comprehensive evaluation,” they say. “A comprehensive evaluation should include a standardized cognitive test to objectively quantify the memory and other thinking changes, a clinical interview, and laboratory tests to evaluate for treatable causes. For many patients, brain imaging, such as CT or MRI scans, and a referral to a dementia specialist may be indicated."

What doctors should do

The researchers also note the important role of health care providers in working to limit disparities in dementia treatment based on race, ethnicity or socioeconomic factors.

"We recommend that primary care providers routinely ask all older patients about changes in memory and thinking skills, just as they would routinely check for other health factors like high blood pressure or hearing loss,” Possin and Tsoy say.

If a concern arises, they recommend primary care providers conduct a standardized cognitive assessment. The UCSF Memory and Aging Center has a “5-Step Brain Health Work-up” portal available to primary care providers. The researchers also suggest dementia specialists consider reaching out to underserved communities to reduce treatment inequities.

More research needed

In the editorial, Kawas and her colleagues point to the need for more diversity in dementia research — particularly as the aging U.S. population grows more diverse.

"Most of what we know today about risk and protective factors for dementia, treatment effects, and biomarkers related to cognitive impairment is derived from highly educated, urban dwelling, non-Hispanic white individuals,” they wrote. “Recruiting diverse populations into research requires directed resources to cultivate trust and engage with different communities. Importantly, physicians must be made aware of the disproportionate effect of dementia in underrepresented and diverse communities and fully recognize the biases of the medical establishment in the diagnosis and care of these underserved individuals.”

Peter Urban is a contributing writer and editor who focuses on health news. Urban spent two decades working as a correspondent in Washington, D.C., for daily newspapers in Connecticut, Massachusetts, Ohio, California and Arkansas, including a stint as Washington bureau chief for the Las Vegas Review-Journal. His freelance work has appeared in Scientific American, Bloomberg Government and

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