Ethnic Disparities in Clinical Presentation of Patients with Early-Onset Alzheimer’s Disease
Meredith Yang1, Suemin Jasmine Yoon 2, Rachel Covaciu2, Kaitlin Seibert2
1University of Chicago Pritzker School of Medicine, 2Department of Neurology, University of Chicago
Background:
Early-onset Alzheimer’s Disease (EOAD) affects patients younger than age 65 and may present with non-amnestic features. Black patients are half as likely to be diagnosed despite twice as many risk factors. Ethnic disparities in EOAD have not been fully characterized.
Design/Methods:
We retrospectively identified EOAD patients February 2017-February 2022 and collected data on ethnicity, level of education, Montreal Cognitive Assessment (MoCA) scores and clinical presentation.
Results:
Of 88 total patients, 60 (68.8%) identified as Caucasian/White and 28 (31.8%) identified as African American/Black. Age at diagnosis (years) was (57.3 ± 5.24) in Black patients compared to (55.9 ± 5.69) in White patients. Time to diagnosis (years) was on average longer in Black patients (5 ± 9.21) compared with White patients (3.5 ± 6.44) and Black patients were on average more advanced (total MOCA scores) at presentation (12.17 ± 6.91) compared with White patients (15.15 ± 5.92) despite similar education level (in years) among Black patients (14.71 ± 2.30) and White patients (15.21±3.00).
An amnestic profile was more common in Black patients (19 or 67.9%) than non-amnestic presentations (9 or 32.1%), although 2 patients (7.14%) presented with visual symptoms suggestive of posterior cortical atrophy (PCA), 5 (17.9%) patients had prominent language symptoms suggestive of logopenic primary progress aphasia (l-PPA) and 1 (3.6%) patient had an executive presentation, suggestive of frontal variant of AD (fAD). Comparatively, non-amnestic presentations were more commonly diagnosed in White patients, with 11 (18.3%) PCA diagnoses, 10 (16.7%) patients with fAD and 8 (13.3%) patients with l-PPA.
Conclusions:
In our cohort, Black patients with EOAD are on average older, more advanced and experience longer delays in diagnosis than their White counterparts. Non-amnestic presentations are more common in White patients. Further work is needed to further characterize the barriers to diagnosis accessibility of care for Black patients with EOAD.