STRESS OF POVERTY, RACISM RAISE RISK OF ALZHEIMER’S

The Denver Post - - FRONT PAGE - By Fre­drick Kunkle

A new group of stud­ies into racial dis­par­i­ties among peo­ple with Alzheimer’s dis­ease sug­gests that so­cial con­di­tions, in­clud­ing the stress of poverty and racism, sub­stan­tially raise the risks of de­men­tia for African-Amer­i­cans.

In four stud­ies, re­searchers found that con­di­tions that af­fect blacks dis­pro­por­tion­ately com­pared with other groups — such as poor liv­ing con­di­tions and stress­ful events such as the loss of a sib­ling, the di­vorce of one’s par­ents or chronic un­em­ploy­ment — have se­vere con­se­quences for brain health later on.

One study by Univer­sity of Wis­con­sin re­searchers found that stress lit­er­ally takes years off a per­son’s life in terms of brain func­tion — an av­er­age of four years for African-Amer­i­cans, com­pared with 1½ years for whites.

Another Wis­con­sin study showed that liv­ing in a dis­ad­van­taged neigh­bor­hood is as­so­ci­ated with later de­cline in cog­ni­tive func­tion and even the biomark­ers linked to Alzheimer’s dis­ease, which is the most com­mon form of de­men­tia.

In the other two stud­ies, re­searchers with Kaiser Per­ma­nente and the Univer­sity of Cal­i­for­nia-San Fran­cisco found a higher de­gree of de­men­tia risk for peo­ple born in states with high rates of in­fant mor­tal­ity. Re­searchers at Kaiser Per­ma­nente and the Univer­sity of Cal­i­for­nia-Irvine found that racial dis­par­i­ties in the in­ci­dence of de­men­tia that were pre­vi­ously found among peo­ple who are 65 years and older also ap­pear in the very old­est de­mo­graphic, peo­ple who are 90 or more.

These life­long ef­fects of stress and dis­ad­van­tage could be direct, per­haps in line with pre­vi­ous re­search show­ing that sus­tained stress can phys­i­cally al­ter the brain. Or the im­pact could be the re­sult of cas­cad­ing ef­fects, such as when a pow­er­fully dis­rup­tive event af­fects a per­son’s early school­ing and lim­its achieve­ment later on.

“No one’s look­ing at the same kind of things, but the re­search all dove­tails re­ally well,” said Me­gan Zuels­dorff, an epi­demi­ol­o­gist with the Univer­sity of Wis­con­sin School of Medicine and Pub­lic Health. “It is the so­cial en­vi­ron­ment that’s con­tribut­ing to dis­par­i­ties.”

She and other re­searchers said the over­all thrust of the stud­ies’ find­ings, pre­sented pub­licly Sun­day, not only of­fer ad­di­tional ev­i­dence of racial in­equities in peo­ple’s risk of de­men­tia but sug­gest the need for more-ur­gent in­ter­ven­tions di­rected at those com­mu­ni­ties.

“Not one of these things is good news — ex­cept that they are mod­i­fi­able,” Zuels­dorff said.

Over the years, re­searchers have the­o­rized that blacks are more sus­cep­ti­ble to Alzheimer’s be­cause of ge­net­ics and higher rates of obe­sity, di­a­betes, hy­per­ten­sion and car­dio­vas­cu­lar dis­ease.

But re­searchers in re­cent years have been fo­cused on so­cial fac­tors that might raise the risk. It’s long been known that stress is as­so­ci­ated with so­cial dis­ad­van­tage, and in the United States and other coun­tries, mem­bers of mi­nor­ity groups of­ten suf­fer dis­pro­por­tion­ally from those dis­ad­van­tages.

Paola Gil­sanz, a re­searcher with the Univer­sity of Cal­i­for­nia-San Fran­cisco and Kaiser Per­ma­nente’s Divi­sion of Re­search, at­tempted to ex­am­ine the im­pact on brain health on peo­ple who had been born in states with high lev­els of in­fant mor­tal­ity, a sort of proxy for begin­ning life un­der ad­verse cir­cum­stances. Dur­ing the pe­riod she fo­cused on, the black in­fant mor­tal­ity rate was nearly twice as high as whites’.

The study re­viewed clin­i­cal exam data col­lected be­tween 1964 and 1973 for 6,284 Kaiser Per­ma­nente mem­bers, of whom 17 per­cent were black. The sub­jects were born be­tween 1919 and 1932.

Re­searchers then an­a­lyzed their health records in re­gard to whether they had been born in one of 10 states with the high­est in­fant mor­tal­ity rates in 1928 — a year cho­sen be­cause of the stark dif­fer­ence be­tween white and black in­fant mor­tal­ity rates and that year’s place to­ward the lower range of ages among the sub­jects of the study.

African-Amer­i­cans born in those states had a 40 per­cent higher risk of de­men­tia than blacks who were not born in states with high in­fant mor­tal­ity rates. The risk was twice as high, even af­ter ac­count­ing for dif­fer­ences in ed­u­ca­tion and other health risk fac­tors, as it was for whites born out­side states with high in­fant mor­tal­ity rates.

“I think this is im­por­tant be­cause it con­trib­utes more in­for­ma­tion to a grow­ing body of ev­i­dence that early life mat­ters to brain health and that maybe early life con­di­tions par­tially ex­plain the racial dis­par­i­ties we see in de­men­tia risk,” Gil­sanz said. “We should re­ally think about brain health as a life­long con­cern.”

Amy J. Kind, who is also a physi­cian and re­searcher at the Univer­sity of Wis­con­sin, looked to see whether there is a re­la­tion­ship be­tween dis­ad­van­taged neigh­bor­hoods and dis­par­i­ties in the preva­lence of de­men­tia. She and her col­leagues first re­fined Cen­sus and Amer­i­can Com­mu­nity Sur­vey data to map more than 34 mil­lion neigh­bor­hoods — blocks of 1,500 to 3000 peo­ple — based on so­cioe­co­nomic data to ar­rive at an Area De­pri­va­tion In­dex. Af­ter rank­ing those blocks from least dis­ad­van­taged to most, the re­searchers then com­pared them with the Wis­con­sin Reg­istry for Alzheimer’s Pre­ven­tion study data of nearly 1,500 peo­ple who had been tested for mem­ory and cog­ni­tive func­tion. The group also an­a­lyzed the neigh­bor­hood data against a much smaller sub­set of peo­ple who had been tested for biomark­ers — pro­teins found in cere­brospinal fluid linked to Alzheimer’s.

The re­searchers found that peo­ple in the most dis­ad­van­taged neigh­bor­hoods per­formed sig­nif­i­cantly worse in ev­ery as­pect of cog­ni­tive func­tion that was tested; they also had dis­pro­por­tion­ately higher lev­els of an Alzheimer’s biomarker.

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