AFRO AMERICAN HEALTH
Black patients face delays in Alzheimer’s diagnosis
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BRAIN MRI IMAGES.
view moreCREDIT: RSNA/JOSHUA WIBECAN, M.D.
CHICAGO – Black patients underwent medical imaging for cognitive impairment years later than white and Hispanic patients and were less frequently tested with MRI, according to research being presented this week at the annual meeting of the Radiological Society of North America (RSNA).
Previous studies have shown that Black patients are at increased risk of Alzheimer’s disease and other types of dementia. They are less likely to have a diagnosis and are diagnosed at a more advanced stage of disease compared to white patients.
Medical imaging—ideally with MRI—plays an increasingly important role in the diagnostic work-up of cognitive impairment. However, it is unknown how disparities in imaging access may lead to these delays in cognitive impairment diagnoses.
“If disparity in obtaining access to neuroimaging is one possible barrier that delays diagnosis, it is important to identify this and figure out possible solutions to benefit these patients and prevent a delayed diagnosis,” said study lead author Joshua Wibecan, M.D., radiology resident at Boston Medical Center in Boston, Massachusetts.
Drawing from four years of data, Dr. Wibecan and colleagues studied imaging disparities at their safety net academic medical center. A safety net medical center provides health care for people regardless of their insurance status or ability to pay.
The researchers identified all outpatient CTs of the head, CT angiographies of the head and MRI brain examinations performed for cognitive impairment. They obtained patient self-identified race from the Boston Medical Center Clinical Data Warehouse for Research.
Self-identified Black/African American patients were imaged for cognitive impairment at an older age and were less frequently imaged for cognitive impairment with MRI. While CT and MRI can both be useful in detection of cognitive impairment and dementia diagnoses, MRI provides much more detail about brain abnormalities.
The average age at imaging for cognitive impairment among the groups with Black patients was 72.5 years, compared with 67.8 years for white patients, 66.5 years for Hispanics and 66.7 years for the Other group. Only 50.9% of Black patients underwent MRI testing for cognitive impairment, compared to 60% of white patients, 67% of Hispanics and 68.2% in the Other group.
“Our study demonstrates two main findings,” Dr. Wibecan said. “First, Black patients who received MRI or CT for cognitive impairment were significantly older than patients from other races. Second, Black patients were significantly less likely to be imaged with MRI, the optimal type of imaging for cognitive impairment, as opposed to CT.”
Early imaging evaluation is important to identify treatable causes of cognitive impairment, such as tumors, bleeding or swelling within the brain. Additionally, new treatments have recently become available for Alzheimer’s disease that can potentially slow the rate of decline. Earlier diagnosis may, therefore, lead to early treatment and a longer period of better cognitive function.
“As treatment for Alzheimer’s Disease improves, it will be even more important to identify patients at early stages of disease for optimal treatment,” Dr. Wibecan said.
Further research is needed, Dr. Wibecan said, to understand why there was a significant difference in the types of imaging exams ordered for the workup of cognitive impairment across racial groups.
Chad W. Farris, M.D., Ph.D., neuroradiologist from Boston Medical Center and assistant professor of radiology at Boston University Chobanian & Avedisian School of Medicine, co-authored the study.
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Note: Copies of RSNA 2023 news releases and electronic images will be available online at RSNA.org/press23.
RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)
Editor’s note: The data in these releases may differ from those in the published abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA Newsroom at 1-312-791-6610.
For patient-friendly information on brain MRI and CT, visit RadiologyInfo.org
Adding a few servings of whole grains linked to slower memory decline in Black people
MINNEAPOLIS – Black people who eat more foods with whole grains, including some breads and cereals, quinoa, and popcorn, may have a slower rate of memory decline compared to Black people who eat fewer whole grain foods, according to a study published in the November 22, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The researchers did not see a similar trend in white participants.
The study does not prove that eating more whole grains slows memory decline; it only shows an association.
The study found that among Black people, those who ate the most whole grains had lower levels of memory decline—equivalent to being 8.5 years younger than those who ate small amounts of whole grains.
“With Alzheimer’s disease and dementia affecting millions of Americans, finding ways to prevent the disease is a high public health priority,” said study author Xiaoran Liu, PhD, MSc, of Rush University in Chicago. “It’s exciting to see that people could potentially lower their risk of dementia by increasing their diet of whole grains by a couple of servings a day.”
The study involved 3,326 people with an average age of 75 without dementia. Of all participants, 1,999 people, or 60%, were Black. They were followed for an average of six years.
They filled out a questionnaire every three years on how often they ate whole grains. They also completed cognitive and memory tests every three years, including recalling lists of words, remembering numbers and putting them in the correct order.
Participants were then divided into five groups based on the amount of whole grains they had in their diet. The lowest group consumed less than half a serving per day, and the highest group consumed 2.7 servings per day. The Dietary Guidelines for Americans recommend at least three servings of whole grain foods daily. One serving of whole grains is equivalent to an ounce of food, such as one slice of bread, a half cup of cooked pasta or rice, an ounce of crackers or a cup of dry cereal.
Researchers found that a higher proportion of Black participants had more than one serving per day of whole grains than white participants, with 67% and 38%, respectively.
To determine rates of cognitive decline, researchers used an overall global cognition score summarizing four cognitive tests and examined their change over time.
After adjusting for factors that could affect the rate of cognitive decline, such as age, sex, education and smoking, researchers found that the global cognitive score of Black people who had the highest intake of whole grains, or more than three servings a day, declined at a rate of 0.2 standard deviation units per decade more slowly than Black people who had the lowest intake, or less than one serving per day.
“These results could help medical professionals make tailored diet recommendations,” Liu added. “More large studies are needed to validate our findings and to further investigate the effect of whole grains on cognition in different racial groups.”
A limitation of the study is that the food frequency questionnaire was self-reported, so people may not accurately remember what they ate.
The study was supported by the Alzheimer's Association and the National Institutes of Health.
Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
Depression, anxiety, and stress frequently co-occur in Black pregnant individuals
In a study of 452 patients, 62% reported depression in combination with anxiety or stress
November 22, 2023 — Black pregnant individuals frequently experience more than one mental health concern, according to findings published by Susan Gennaro, PhD, RN, FAAN, Professor in the William F. Connell School of Nursing at Boston College, and colleagues in The Nurse Practitioner. They say prenatal screening and treatment for stress is warranted in addition to care of depression and anxiety. The Nurse Practitioner is part of the Lippincott portfolio of Wolters Kluwer.
"Prenatal interventions for Black people should aim to address mental health distress and treat high depression, anxiety, and stress," the research group recommends.
Depression, anxiety, and stress are common in Black pregnant people and commonly co-occur
At three U.S. urban clinics, the researchers were involved in determining whether pregnant Black patients were eligible for a trial of cognitive–behavioral therapy tailored to racial/ethnic minority people. At less than 19 weeks of gestation, 452 patients ages 18 to 40 completed the Edinburgh Postnatal Depression Scale, the General Anxiety Disorders–7 Scale, and the Perceived Stress Scale.
In total, 194 patients (43%) screened positive for depression, anxiety, and/or stress:
19% were only depressed
1.5% were only anxious
10% were only stressed
3.6% were depressed and anxious
25% were depressed and stressed
8% were anxious and stressed
33% were depressed, anxious, and stressed
All told, then:
81% reported depression alone or with anxiety or stress
46% reported anxiety alone or with depression or stress
76% reported stress alone or with depression or anxiety
The findings support changes in prenatal mental health screening
National prenatal care guidelines call for screening for depression and anxiety, Dr. Gennaro and her colleagues note, but screening is far from universal. "Screening occurs more frequently in the postpartum period than during pregnancy, and, when screened, pregnant people are less likely to receive evidence-based care than when they are postpartum. In fact, over a third of pregnant people have never received screening and these numbers are higher in minorities."
Moreover, the results of this study indicate the necessity of adding screening for stress to prenatal care, the authors say. "While all pregnant people need to be screened, attending school and being younger were additional risk factors and may warrant further consideration for people who have borderline screening scores."
On average, screening for depression, anxiety, and stress in this study added only 10 minutes to the prenatal visit. "Screening using validated tools . . . allows focused attention to the full scope of symptomatology, which is particularly important given the overlap of some mental health symptoms, such as appetite and sleep changes, with normal physiologic adaptations to pregnancy," the researchers explain.
They add that individuals who acknowledge self-harm on question 10 of the Edinburgh Postnatal Depression Scale should immediately be assessed further so they can be referred to the appropriate care, potentially including emergency psychiatric evaluation or social work.
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.
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About The Nurse Practitioner
With a circulation of 75,000, The Nurse Practitioner is the leading monthly source for clinical, practical, cutting-edge information for advanced practice nurses and other primary care clinicians. Each issue presents peer-reviewed articles that range from clinical topics and research to political and practice issues. In addition, The Nurse Practitioner provides regular features, columns, continuing education, staff development education, and more.
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JOURNAL
The Nurse Practitioner
ARTICLE TITLE
Depression, anxiety, and stress in pregnant Black people: A case for screening and evidence-based intervention
ARTICLE PUBLICATION DATE
22-Nov-2023
