Analyzing America’s Alzheimer’s hotspot: Why are rates of memory-robbing disease so high in the Democrat-run, affluent state of Maryland?

The state of Maryland ranks first for the highest rate of Alzheimer’s disease in the United States, despite doing better in obesity, household income and residents with health insurance.

The traditionally Democratic state, located next to the nation’s capital, has more than one in eight people aged 65 and over with the condition, compared with about one in 10 nationally.

Maryland is also the only state with two counties with the top 10 highest Alzheimer’s rates. Baltimore City tied for first with 16.6 percent of people over 65 and Prince George’s County ranked fourth with 16.1 percent –

The findings are detailed in the first-ever report on Alzheimer’s disease at the provincial level, published in The Journal of the Alzheimer’s Association.

Megeen White, a medical research advocate for the Maryland chapter of the Alzheimer’s Association, said, “The study just confirms that it is indeed a health crisis in our community, we need to address it as such.”

Dr. Kumar Rajan, author of the report, said the disease’s prevalence in Maryland is due to a higher number of black and Hispanic residents.

These minority groups may have higher rates of dementia, health experts say, because they are more likely to suffer from heart disease, diabetes and high blood pressure – all conditions that affect brain health.

Previous research has found that older black Americans are twice as likely to develop Alzheimer’s disease or other forms of dementia than older whites, and that older Hispanics are about 1.5 times more likely to develop the disease than their white counterparts, due to confounding factors such as comorbidity and social aspects, such as racism. and discrimination.

Diabetes is more common among black Americans, at a rate of 12 percent, and among Hispanics at a rate of 11.8 percent. Among white Americans, this rate is 7.4 percent.

High blood pressure is also more common among black Americans (56 percent) than white Americans (48 percent).

Of Baltimore City’s nearly 570,000 residents, 62.3 percent are black, compared to the national average of 9.4 percent, and 6.3 percent are Hispanic, although the national average is higher at 8.8 percent.

And across Maryland, the number of minorities is also higher than average. In the state, 31.7 percent of residents are black and 11.5 percent are Hispanic.

New York was a close second to Maryland, with an Alzheimer’s prevalence of 12.7 percent. However, New York has a lower percentage of minorities among the total population. Just under 18 percent of New Yorkers are black and 19.7 percent are Hispanic.

New York’s Bronx County, where Baltimore had an Alzheimer’s prevalence of 16.6 percent, had higher minority rates than the national average but still less than Baltimore’s, with 30 percent of the population identifying as black and 47 percent as Spanish.

However, New York State had a higher percentage of residents age 65 and older than Maryland: 18.1 percent.

Health experts and Alzheimer’s specialists all agree that age is the greatest risk factor for Alzheimer’s disease, and nearly 16 percent of people in Baltimore City are 65 and older, compared to the national average of 12 percent. In Maryland, 17 percent of residents are 65 and older.

Ms White added: ‘We need to ensure adequate awareness, education and support for everyone involved, but especially for those over 65 years of age.’

In addition to the coexisting medical conditions, the Alzheimer’s Association said the higher prevalence of Alzheimer’s disease among blacks and Hispanics can likely be explained by health and social disparities, as well as the marginalization and discrimination of these groups in the United States, which is deeply rooted in history.

The association highlighted structural racism, which affects housing, education, employment, safety and exposure to pollutants. It also affects access to health care, care and the prevalence of other health problems.

Following a 2022 report from the association that looked at racism and dementia, Dr. Adriana Perez, a nurse practitioner and professor of nursing at the University of Pennsylvania, said: “The persistent and widespread lack of resources, as well as social and environmental factors, lead to disparities in other health outcomes, such as cardiovascular disease and diabetes, which increase the risk of Alzheimer’s disease and other forms of dementia.’

And Dr. Miriam Burnett, medical director of the African Methodist Episcopal Church International Health Commission, echoed these sentiments: “These systemic disparities are related to less access to important health-protective resources, such as high-quality care and social networks that provide valuable health care. information and support.’

The cumulative stress these factors place on a person “may directly influence the risk of dementia” among Black and Hispanic people, the association said.

Recently, Ms. White acknowledged this stress: “(The) study found that both personal and systemic experiences of racism are most likely to increase an individual’s risk for Alzheimer’s disease or other forms of dementia. This could possibly be related to the increased stress levels in the body.’

Dr. Keith Vossel, Alzheimer’s disease program director at the department of neurology at the University of California, Los Angeles, told DailyMail.com that marginalized groups experience stress, violence, discrimination and racism. All these life experiences can influence epigenetic changes.

While genetic changes change genes, epigenetic changes affect gene expression. Epigenetic changes do not physically alter DNA, but rather change the way a gene is expressed.

Dr. Vossel said: ‘These experiences can be passed on from generation to generation through epigenetic changes.’

Genetics also plays a strong role in Alzheimer’s risk, and in 2022 researchers identified 31 new genes that appear to influence processes involved in the disease.

Of the genes, one called APOE-e4 has the strongest impact on risk.

Everyone inherits one of three forms of the APOE gene from their parents – e2, e3 or e4 – and scientists found that having the e4 form of the APOE gene increases the risk of developing the disease the most.

People who inherit one copy of this gene have three times the risk, and people who inherit two copies of e4 have an estimated eight- to 12-fold risk of developing dementia. These people are also more likely to develop the disease at a younger age.

African Americans are more likely than other races to have this gene.

However, researchers emphasized that this is still a new discovery and there are other aspects that contribute more to an increased risk that need to be addressed.

Maryland previously recognized the state’s high rates of Alzheimer’s disease, releasing a four-year plan to tackle the disease and passing a law to increase access to home care for people with dementia.

The plan’s goals to tackle the ‘crisis’ include raising public awareness, educating people about the disease, improving quality of care, supporting caregivers and promoting innovation through data and research.

Education and communication are two major obstacles that minority populations and the health care community must overcome when it comes to diagnosing and treating Alzheimer’s, Dr. Vossel said.

While distrust leads to a lack of communication, Dr. Vossel says many people wonder why there aren’t doctors “who look like them” working with dementia patients.

He added: ‘Unfortunately there are not enough neurologists and dementia specialists from underrepresented groups. Doctors must be able to identify with their community.’

In addition to a lack of minority physicians, there is also a lack of access to physicians and healthcare facilities in general.

Dr. Vossel has heard from the community that they have transportation problems to reach health care facilities and that large or prestigious institutions that provide dementia care are not in their area, severely limiting patients’ ability to receive proper diagnosis and treatment in a timely manner.

Addressing the high rates of dementia among minority groups will require a multifaceted approach and Dr. Vossel said this will require everything from establishing a stable education system that meets the needs of all its students, developing measures to combat heart disease and diabetes, implementing dementia. screenings at routine doctor visits and allowing doctors to be reimbursed for those screenings.