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Prevalence of dementia in African–Caribbean compared with UK-born White older people: two-stage cross-sectional study

  • Simon Adelman (a1), Martin Blanchard (a1), Greta Rait (a2), Gerard Leavey (a3) and Gill Livingston (a4)...

Abstract

Background

Preliminary studies in the UK, all using screening instruments of unknown cultural validity, indicate that there may be an increased prevalence of dementia in African–Caribbean people, possibly related to vascular risk factors and potentially amenable to preventative measures.

Aims

To determine the prevalence of dementia in older people of African–Caribbean country of birth compared with their White UK-born counterparts.

Method

A total of 218 people of African–Caribbean country of birth and 218 White UK-born people aged ⩾60 years were recruited from five general practices in North London. Those who screened positive for cognitive impairment using a culturally valid instrument were offered a standardised diagnostic interview. Two independent assessors diagnosed dementia according to standard operationalised criteria.

Results

African–Caribbean participants were 2 years younger, and those with dementia nearly 8 years younger than their White counterparts. The prevalence of dementia was significantly higher in the African–Caribbean (9.6%) than the White group (6.9%) after adjustment for the confounders age and socioeconomic status (odds ratio (OR) = 3.1, 95%CI 1.3–7.3, P = 0.012).

Conclusions

There is an increased prevalence of dementia in older people of African–Caribbean country of birth in the UK and at younger ages than in the indigenous White population. These findings have implications for service provision and preventive interventions. Further research is needed to explore the role of vascular risk factors and social adversity in the excess of dementia in this population.

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Copyright

Corresponding author

Simon Adelman, Department of Mental Health Sciences, UCL, 67–73 Riding House Street, 2nd Floor, Charles Bell House, London W1W 7EJ, UK. Email: simon.adelman@candi.nhs.uk

Footnotes

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The study was funded by the Medical Research Council and sponsored by University College London.

Declaration of interest

None.

Footnotes

References

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1 Ferri, CP, Prince, M, Brayne, C, Brodaty, H, Fratiglioni, L, Ganguli, M, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366: 2112–7.
2 Tang, MX, Cross, P, Andrews, H, Jacobs, DM, Small, S, Bell, K, et al. Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology 2001; 56: 4956.
3 Demirovic, J, Prineas, R, Loewenstein, D, Bean, J, Duara, R, Sevush, S, et al. Prevalence of dementia in three ethnic groups: the South Florida program on aging and health. Ann Epidemiol 2003; 13: 472–8.
4 Krishnan, LL, Petersen, NJ, Snow, AL, Cully, JA, Schulz, PE, Graham, DP, et al. Prevalence of dementia among Veterans Affairs medical care system users. Dement Geriatr Cogn Disord 2005; 20: 245–53.
5 Heyman, A, Fillenbaum, G, Prosnitz, B, Raiford, K, Burchett, B, Clark, C. Estimated prevalence of dementia among elderly black and white community residents. Arch Neurol 1991; 48: 594–8.
6 Folstein, MF, Bassett, SS, Anthony, JC, Romanoski, AJ, Nestadt, GR. Dementia: case ascertainment in a community survey. J Gerontol 1991; 46: M132–8.
7 Auchus, AP. Dementia in urban black outpatients: initial experience at the Emory satellite clinics. Gerontologist 1997; 37: 25–9.
8 Adelman, S, Blanchard, M, Livingston, G. A systematic review of the prevalence and covariates of dementia or relative cognitive impairment in the older African-Caribbean population in Britain. Int J Geriatr Psychiatry 2009; 24: 657–65.
9 Skoog, I. Antihypertensive treatment and dementia prevention. Lancet Neurol 2008; 7:664–5.
10 Diez-Roux, AV, Chamberless, L, Merkin, SS. Socioeconomic disadvantage and change in blood pressure associated with ageing. Circulation 2002; 106: 7.
11 King, M, Coker, E, Leavey, G, Hoare, A, Johnson-Sabine, E. Incidence of psychotic illness in London: comparison of ethnic groups. BMJ 1994; 309: 1115–9.
12 Kirkbride, JB, Boydell, J, Ploubidis, GB, Morgan, C, Dazzan, P, McKenzie, K, et al. Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychol Med 2008; 38: 1083–94.
13 Department of Health. National Standards for Ethnic Group and Related Matters. Department of Health, 2001 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_5319155).
14 Office for National Statistics. The National Statistics Socio-economic Classification User Manual (2005 edition). Palgrave Macmillan, 2005.
15 Rait, G, Morley, M, Burns, A, Baldwin, R, Chew-Graham, C, St Leger, AS. Screening for cognitive impairment in older African-Caribbeans. Psychol Med 2000; 30: 957–63.
16 Molloy, DW, Alemayehu, E, Roberts, R. Reliability of a Standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. Am J Psychiatry 1991; 148: 102–5.
17 Roth, M, Tym, E, Mountjoy, CQ, Huppert, FA, Hendrie, H, Verma, S, et al. CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986; 149: 698709.
18 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO, 1993.
19 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM–IV–TR). APA, 2000.
20 Petersen, RC, Smith, GE, Waring, SC, Ivnik, RJ, Tangalos, EG, Kokmen, E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56: 303–8.
21 McKhann, G, Drachman, D, Folstein, M, Katzman, R, Price, D, Stadlan, EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34: 939–44.
22 Roman, GC, Tatemichi, TK, Erkinjuntti, T, Cummings, JL, Masdeu, JC, Garcia, JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993; 43: 250–60.
23 McKeith, IG, Dickson, DW, Lowe, J, Emre, M, O'Brien, JT, Feldman, H, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005; 65: 1863–72.
24 McKhann, GM, Albert, MS, Grossman, M, Miller, B, Dickson, D, Trojanowski, JQ. Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick's Disease. Arch Neurol 2001; 58: 1803–9.
25 Miles, J, Shevlin, M. Applying Regression and Correlation: A Guide for Students and Researchers. Sage Publications, 2001.
26 Jorm, AF, Korten, AE, Henderson, AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand 1987; 76: 465–79.
27 Folstein, MF, Folstein, SE, McHugh, PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
28 Parker, C, Philp, I. Screening for cognitive impairment among older people in black and minority ethnic groups. Age Ageing 2004; 33: 447–52.
29 Johnson, MR, Cross, M, Cardew, SA. Inner-city residents, ethnic minorities and primary health care. Postgrad Med J 1983; 59: 664–7.
30 Richards, M. Surveying African Caribbean elders in the community: implications for research on health and health service use. Int J Ger Psychiatry 1996; 11: 41–5.
31 Livingston, G, Leavey, G, Kitchen, G, Manela, M, Sembhi, S, Katona, C. Mental health of migrant elders – the Islington study. Br J Psychiatry 2001; 179: 361–6.
32 McCracken, CF, Boneham, MA, Copeland, JR, Williams, KE, Wilson, K, Scott, A, et al. Prevalence of dementia and depression among elderly people in black and ethnic minorities. Br J Psychiatry 1997; 171: 269–73.
33 Richards, M, Brayne, C, Dening, T, Abas, M, Carter, J, Price, M, et al. Cognitive function in UK community-dwelling African Caribbean and white elders: a pilot study. Int J Geriatr Psychiatry 2000; 15: 621–30.
34 Fish, M, Bayer, AJ, Gallacher, JE, Bell, T, Pickering, J, Pedro, S, et al. Prevalence and pattern of cognitive impairment in a community cohort of men in South Wales: methodology and findings from the Caerphilly Prospective Study. Neuroepidemiology 2008; 30: 2533.
35 Knapp, M. Dementia UK - The Full Report. London School of Economics, King's College London, 2007.

Prevalence of dementia in African–Caribbean compared with UK-born White older people: two-stage cross-sectional study

  • Simon Adelman (a1), Martin Blanchard (a1), Greta Rait (a2), Gerard Leavey (a3) and Gill Livingston (a4)...

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Prevalence of dementia in African–Caribbean compared with UK-born White older people: two-stage cross-sectional study

  • Simon Adelman (a1), Martin Blanchard (a1), Greta Rait (a2), Gerard Leavey (a3) and Gill Livingston (a4)...
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eLetters

Risk factors associated with dementia in African-Carribean population and culturally appropriate assessment tools

Farooq Ahmed Khan, Psychiatrist - Specialist Registrar
24 August 2011

Studies have quoted that comparing Yoruba-Africans in Ibadan, African-Americans have a 2-fold higher incidence of Alzheimer's disease, a 10-fold greater prevalence of stroke, a further 10-fold increase in diabetes,and a 3-fold increase in hypertension. (Hendrie HC, Ogunniyi A, Hall KS, et al. 2001). Among African Americans, once hypertension is identified, itwas found that they fail to seek treatment and terminate treatment prematurely (Sue et al., 2000). This pattern has not been restricted only to the African-Carribean population but studies have shown similar trends among Chinese, Hispanic Americans and Indian populations.

Cultural, language and ethnic belief systems play an important role in assessment and management of these ethnic minority populations. Some efforts have been made but more needs to be done to improve and include these populations in the mainstream for betterment of their care. Translated versions of MMSE are available in Hindi, Gujrati, Punjabi, Bengali, Chinese and Afro-Caribbean languages, but who and how professionals are going to use them without sufficient training. There is a high risk of the BME groups being wrongly labeled as having Cognitive Impairment if only the standard english version of MMSE or other tests areused for the screening. A study found that 6% of non-impaired White peopleand 42% of non-impaired Black people were wrongly picked up by MMSE (Fillenbaum et al., 1990).

In the UK as a whole the National Dementia Strategy stresses the needfor improving services for British Minority Ethnic groups but a commitmentfrom professionals is needed to address this significant issue.

References:1. Hendrie HC, Ogunniyi A, Hall KS, et al. (2001) Incidence of dementia and Alzheimer disease in 2 communities: Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana. JAMA; 285:739-747.

2. Sue D, Eisler RM, Hersen M (2000) Health risk factors in diverse cultural groups. In: (eds). Handbook of Gender, Culture, and Health. Mahwah NJ: Lawrence Erlbaum: 85-104.

3. 28.Fillenbaum G, Heyman A, Williams K, Prosnitz B, Burchett B. (1990) Sensitivity and specificity of standardized screens of cognitive impairment and dementia among elderly black and white community residents.Journal of Clinical Epidemiology; 43: 651-60.

... More

Conflict of interest: None declared

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Re: Need to identify modifiable risk factors of dementia in older UK African-Caribbean population

Simon Adelman, Consultant & Director
15 July 2011

Thank you for your positive comments about the importance of our research
 (1). We agree that it is helpful to emphasize that we do not know
 whether vascular factors are the primary aetiology behind the increased prevalence of dementia in this population. We considered literacy to be a risk, and this like our earlier study controlled for education (2) and found no difference between ethnic groups. Similarly, depression rates in
 older black populations have not been found to be raised (2); nor has the
 prevalence of APOE4 when compared to their white counterparts. 
However, there are contradictory findingsabout whether the expression may be the same (3 4 5 6). Thus while all these factors may relate to the rates of AD, there was no clear evidence to suggest they are
 responsible for the increased rate in the African-Caribbean group. Finally, there is no evidence that the prevalenceof dementia in the participant’s Countries of Birth (Caribbean Islands) islower than that for the UK. A Delphi consensus study estimated that rate for Latin America and the Caribbean, are at least as high as for Western Europe (7). We agree however that more research 
is needed to consider the possible aetiology and modifiable risk factors.

Declaration of interest: This study funded by the Medical Research Council and sponsored by UCL.

1 Adelman S, Blanchard M, Rait G, Leavey G, Livingston G. 
(2011) Prevalence of
dementia in African-Caribbean compared with UK-born White older people:
two-stage cross-sectional study. BrJ Psychiatry. [Epub ahead of print]


2 Livingston G, Leavey G, Kitchen G, Manela M, Sembhi S, Katona C. 
(2001) Mental health of migrant elders--the Islington study. Br J Psychiatry. 179:361-6.


3 Stewart R, Russ C, Richards M, Brayne C, Lovestone S, Mann
A. (2001) Depression, APOE genotype and subjective memory impairment: a
cross-sectional study in an African-Caribbean population Psychol Med. 31(3):431-40.


4 A.Farrer, L. A., Cupples, L. A., Haines, J. L., et al (1997) Effects
of age, sex and ethnicity
on the association between apolipoprotein E genotype and Alzheimer
disease. A meta-analysis.
JAMA, 278, 1349–1356.



5 The APOE-epsilon4 allele and the risk of Alzheimer disease among
African Americans, whites, and Hispanics.

Tang MX, Stern Y, Marder K, Bell K, Gurland B, Lantigua R, Andrews H,
Feng L, Tycko B, Mayeux R.

(1998) JAMA. 11;279(10):751-5.



6 Murrell JR, Price B, Lane KA, Baiyewu O, Gureje O, Ogunniyi A,
Unverzagt FW, Smith-Gamble V, Gao S, Hendrie HC, Hall KS. (2006)
 Association of apolipoproteinE genotype and Alzheimer disease in African Americans. Arch Neurol.63(3):431-4.

7. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni, L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E & Scazufca M. (2005) Global prevalence of dementia: a Delphi Consensus Study. Lancet 366, 2112-7
... More

Conflict of interest: None Declared

Write a reply

Need to identify modifiable risk factors of dementia in older UK African-Caribbean population

Om Prakash, Associate Professor of Psychiatry, Consultant in Adult & Geriatric Psychiatry
29 June 2011

To the editor:The article by Adelman and his colleagues (1) made an important contribution in exploring dementia in older people of African–Caribbean country of birth in the UK. This article paves a way for policymakers in assessing public health implications of this ubiquitous condition in termsof care burden and economic impact. However, this research study raises important issues.Previous studies (2) consistently indicate increased tendency of dementia in older African-Caribbean people when compared to the indigenous white population in UK. The magnitude of this difference in between these populations is not clear. Hence, there is a definite need of well-planned epidemiological study to find actual burden of disease.Surprisingly, this study presumed (1) that vascular factors such as hypertension and type 2- diabetes are likely to increase the burden of dementia in African-Caribbean population. However, the possibility of other risk factors like depression, illiteracy and prevalence of APOE 4 needs more emphasis(3,4) which, presumably, increase the chances of subsequent dementia. Current data from sub-Saharan Africa and India (4) suggest that age-adjusted dementia prevalence estimates in 65 year olds are low (1-3%) as compared to rest other developing countries. It appears that there is needto identify potentially modifiable environmental or genetic factors to justify the increased prevalence in dementia when this population migratedto UK. Therefore, future studies are needed to identify these risk factorsin this migrant population.

References:1.Adelman S, Blanchard M, Rait G, Leavey G, Livingston G. Prevalence of dementia in African-Caribbean compared with UK-born White older people: two-stage cross-sectional study. Br J Psychiatry. 2011 Jun 8. [Epub ahead of print]2.Adelman S, Blanchard M, Livingston G. A systematic review of the prevalence and covariates of dementia or relative cognitive impairment in the older African-Caribbean population in Britain. Int J Geriatr Psychiatry. 2009;24(7):657-65.3.Stewart R, Russ C, Richards M, Brayne C, Lovestone S, Mann A. Depression, APOE genotype and subjective memory impairment: a cross-sectional study in an African-Caribbean population. Psychol Med. 2001; 31(3):431-40.4.Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, Luchsinger JA, Ogunniyi A, Perry EK, Potocnik F, Prince M, Stewart R, WimoA, Zhang ZX, Antuono P; World Federation of Neurology Dementia Research Group. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol. 2008;7(9):812-26.
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Conflict of interest: None Declared

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