Ethnic Disparities in Clinical Presentation of Patients with Early‐Onset Alzheimer’s Disease

Abstract

AbstractBackgroundEarly‐onset Alzheimer’s Disease (EOAD) affects patients under age 65 and may present with non‐amnestic features. Black patients are half as likely as White patients to be diagnosed despite twice as many risk factors. Ethnic disparities in EOAD have not been fully characterized.MethodsWe retrospectively collected data on ethnicity, level of education, Montreal Cognitive Assessment (MoCA) scores on EOAD patients diagnosed between 2017 and 2022 at The University of Chicago Memory Center.ResultsOf 88 total patients, 60 (68.8%) identified as White and 28 (31.8%) identified as Black. Age at diagnosis was 57.3 ± 5.24 years in Black patients compared to 55.9 ± 5.69 years In White patients. Average time to diagnosis was longer in Black patients (5 ± 9.21 yrs.) vs White patients (3.5 ± 6.44 yrs). Black patients had lower MoCA scores than Whites at presentation (12.17 ± 6.91 vs 15.15 ± 5.92), despite similar education levels among Black vs. White patients (14.71 ± 2.30 vs 15.21 ± 3.00).Black patients more commonly displayed an amnestic profile (19 or 67.9%) than a non‐amnestic presentation (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 executive variant of AD (EAD). In White patients, 11 (18.3%) were diagnosed with PCA, 10 (16.7%) with EAD and 8 (13.3%) with l‐PPA.Differences were noted in the application of diagnostic tests, in that neuropsychological testing (NPT) and CSF testing were less often ordered in Black patients (NPT: 8 (29%) in Blacks vs 45 (75%) Whites, p = 0.001; CSF: 4 (14%) Blacks vs 30 (50%) Whites, p = 0.002).ConclusionIn our cohort, Black patients with EOAD were on average older, more advanced, and experience longer delays and differences in diagnostic management than their White counterparts. Further work is needed to characterize the barriers to diagnosis for Black patients with EOAD and the potential differences in clinical presentations.