Black People Less Likely to Receive
Dementia Meds

Megan Brooks

March 03, 2023

Black people living with dementia are less likely than their White peers to receive cognitive enhancers and other medications for dementia in the outpatient setting, preliminary data from a retrospective study show.

"There have been disparities regarding the use of cognition-enhancing medications in the treatment of dementia described in the literature, and disparities in the use of adjunctive treatments for other neuropsychiatric symptoms of dementia described in hospital and nursing home settings," study investigator Alice Hawkins, MD, with the Department of Neurology, Mount Sinai Icahn School of Medicine in New York, told Medscape Medical News.

"However, less is known about use of dementia medications that people take at home. Our study found disparities in this area as well," Hawkins said.

The study was released early, ahead of presentation in Boston next month at the American Academy of Neurology (AAN) Annual Meeting.

More Research Needed

The researchers analyzed data on 3655 Black and 12,885 White patients with a diagnosis of dementia who were seen at Mount Sinai. They evaluated utilization of five medication classes. These included cholinesterase inhibitors, N-methyl D-aspartate (NMDA) receptor antagonists, selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and benzodiazepines.

They found that Black patients with dementia received cognitive enhancers less often than White patients with dementia (20% vs 30% for cholinesterase inhibitors; 10% vs17% for NMDA-antagonists).

Black patients with dementia were also less likely to receive medications for behavioral and psychological symptom management compared with White peers (24% vs 40% for SSRIs; 18% vs 22% for antipsychotics; and 18% vs 37% for benzodiazepines).

These disparities remained even after controlling for factors such as demographics and insurance coverage.

"Larger systemic forces such as systemic racism, quality of care, and provider bias are harder to pin down, particularly in the medical record, though they all may be playing a role in perpetuating these inequities. More research will be needed to pinpoint all the factors that are contributing to these disparities," said Hawkins.

The researchers found Black patients who were referred to a neurologist received cholinesterase inhibitors and NMDA antagonists at rates comparable to White patients. "Therefore, referrals to specialists such as neurologists may decrease the disparities for these prescriptions," Hawkins said.

Crucial Research

Commenting on the findings for Medscape Medical News, Carl V. Hill, PhD, MPH, Alzheimer's Association chief diversity, equity, and inclusion officer, said the study "adds to previous research that points to inequities in the administering of medications for dementia symptoms, and highlights the inequities we know exist in dementia care."

"Cognitive enhancers and other behavioral/psychological management drugs, while they don't stop, slow, or cure dementia, can offer relief for some of the challenging symptoms associated with diseases caused by dementia. If people aren't being appropriately prescribed medications that may offer symptom relief from this challenging disease, it could lead to poorer health outcomes," said Hill.

"These data underscore the importance of health disparities research that is crucial in uncovering inequities in dementia treatment, care and research for Black individuals, as well as all underrepresented populations.

"We must create a society in which the underserved, disproportionately affected and underrepresented are safe, cared for, and valued. This can be done through enhancing cultural competence in healthcare settings, improving representation within the healthcare system, and engaging and building trust with diverse communities," Hill said.

The Alzheimer’s Association has partnered with over 500 diverse community-based groups on disease education programs to ensure families have information and resources to navigate this devastating disease.

The study was supported by the American Academy of Neurology Resident Research Scholarship. Hawkins and Hill report no relevant financial relationships.

American Academy of Neurology (AAN) 2023 Annual Meeting: Abstract 4547. To be presented April 24, 2023.

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