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Disparities in Care: Understanding the Overlap of Brain Health and Cardiovascular Disease in American Indians

Underserved populations such as American Indians and Alaska Natives are overlooked in a wide array of research studies ranging from observational studies to clinical trials. And that underrepresentation is particularly evident in research on cognitive impairment, Alzheimer’s disease, and cerebrovascular disease. For instance, there are virtually no data on American Indians and Alaska Natives in the National Alzheimer’s Coordinating Centers extensive database from about 30 Alzheimer’s disease centers scattered throughout the country. The database includes 36,327 people, of whom only 225 (0.6 percent) are American Indian or Alaska Native. A unique partnership between Washington State University’s Partnership for Native Health and the University of Washington Alzheimer’s Disease Research Center hopes to change that. Through a funding grant by the National Institute on Aging, American Indians are participating in an ongoing longitudinal study to examine the incidence and long-term effects, risk factors, and links between cardiovascular disease, vascular brain injury, Alzheimer’s disease, and cognitive decline. The long-term goal is to develop tailored interventions for Alzheimer’s disease that account for factors such as aging, environment, and medical and family history for Native populations, said study project leader Astrid SuchyDicey, PhD, assistant research professor at the Elson S. Floyd College of Medicine at Washington State University in Seattle. “Cognitive impairment and Alzheimer’s disease are not well studied in American Indians and our study is the first large-scale effort to examine Alzheimer’s disease in this overlooked community,” said Dr. Suchy-Dicey. “American Indians suffer disproportionately from conditions related to cardiovascular disease and vascular brain injury, but we lack even basic information about prevalence of related outcomes such as Alzheimer’s disease or dementia in this population.” The current gap in information is due to a host of factors. Among them are a lack of validated normative standards upon which to base cognitive test assessments in this group; differences in culture, health perspectives, language, and education; and disparities in access to health care for diagnosis and treatment. “With better information and answers to some of these questions, we hope to be able to treat or reverse some of the consequences, ultimately supporting longer, healthier lives for all people,” Dr. Suchy-Dicey said.