Alzheimer’s Manifests Differently in Hispanic People

Summary: A new study reports Hispanic people not only tend to develop symptoms of Alzheimer’s earlier than other racial groups, they also show earlier manifestations of neuropsychiatric symptoms associated with the disease.

Source: Texas Tech.

Depression and other neuropsychiatric problems appear more frequently in the Hispanic population.

Certain symptoms associated with the development of Alzheimer’s disease, including agitation and depression, affect Hispanics more frequently and severely than other ethnicities. The findings, published in the Journal of Neuropsychiatry and Clinical Neuroscience (JNCN), suggest that Alzheimer’s disease manifests itself differently in Hispanic populations.

“Our study shows that the severity and proportion of neuropsychiatric symptoms is significantly higher in a Hispanic group compared to non-Hispanic whites,” says lead researcher Ricardo Salazar, M.D., a geriatric psychiatrist at Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso). “This could have a significant impact on the treatment and understanding of how Alzheimer’s disease progresses in Hispanics.”

Both cognitive and behavioral decline can occur with Alzheimer’s disease. Cognitive signs of the disease include memory loss and problems with orientation and physical functioning. Behavioral, or neuropsychiatric symptoms, include depression, elation, anxiety, hallucinations, delusions and apathy. These neuropsychiatric symptoms have been associated with higher rates of institutionalization and more rapid progression of the disease.

Curious to understand how neuropsychiatric symptoms manifest in Hispanics with dementia, Dr. Salazar and his team gathered data on more than 2,100 individuals in the Texas Alzheimer’s Research and Care Consortium (TARCC) database. Patients profiled in the database are predominantly non-Hispanic whites and Mexican-Americans who have been diagnosed with Alzheimer’s disease or mild cognitive impairment (MCI), or are otherwise healthy subjects. The team specifically focused on each individual’s Neuropsychiatric Inventory Questionnaire (NPI-Q), an exam used to assess the extent of 12 neuropsychiatric symptoms.

A review of the data showed that during MCI — the intermediate state between healthy cognition and Alzheimer’s disease — all ethnicities were affected equally by neuropsychiatric symptoms. But once the condition had progressed to full-on Alzheimer’s disease, the severity of neuropsychiatric symptoms in Hispanics increased significantly.

Dr. Salazar believes these divergent symptoms may reflect a different disease process in Hispanics.

“When patients have neuropsychiatric symptoms, that signifies deterioration of different areas of the brain,” he explains. “I believe functional imaging studies of the brain may show differences in the locations of amyloid or plaque collection in the brains of Hispanics with Alzheimer’s disease.”

The JNCN study also showed that depression and anxiety were more frequent in healthy Hispanics age 50 years and older than in healthy, non-Hispanic whites of the same age. This corroborates past studies suggesting that depression may be one of the first signs of Alzheimer’s disease.

“Hispanics tend to get Alzheimer’s disease at an earlier age than other [ethnic groups], and our study shows that these neuropsychiatric symptoms of depression and anxiety manifest earlier in them, too,” Dr. Salazar says. “This suggests that depression and anxiety in older Hispanics could be an early warning for Alzheimer’s disease—and that treatment of these symptoms could even delay the disease.”

As a geriatric psychiatrist in an overwhelmingly Hispanic region, Dr. Salazar has witnessed this phenomenon firsthand.

“I am a strong believer that if you use antidepressants to treat MCI that appears with symptoms of depression, you can slow the progression of Alzheimer’s,” he says. “Maybe even avoid full-on progression to the disease.”

Image shows a graph outlining the differences in alzheimer's symptoms.
Comparison of Hispanic and Non-Hispanic Behavioral Symptoms with Alzheimer’s disease. NeuroscienceNews.com image is credited to Texas Tech University Health Sciences Center El Paso.

Dr. Salazar implores physicians to be aware that depression can mask dementia, particularly in the Hispanic population.

Dr. Salazar admits the study has limitations. Ethnicity was self-reported by individuals, and there were also fewer Hispanic participants with Alzheimer’s disease than white participants with the disease.

While additional research is clearly needed, Dr. Salazar’s study could be a window to how to better treat — and even prevent — Alzheimer’s disease in this rapidly-growing demographic.

About this Alzheimer’s disease research article

Source: Veronique Masterson – Texas Tech
Image Source: This NeuroscienceNews.com image is credited to exas Tech University Health Sciences Center El Paso.
Original Research: Abstract for “Cross-Ethnic Differences in the Severity of Neuropsychiatric Symptoms in Persons With Mild Cognitive Impairment and Alzheimer’s Disease” by Ricardo Salazar, M.D., Alok Kumar Dwivedi, Ph.D., and Donald R. Royall, M.D. in Journal of Neuropsychiatry and Clinical Neuroscience . Published online July 15 2016 doi:10.1176/appi.neuropsych.15120423

Cite This NeuroscienceNews.com Article

[cbtabs][cbtab title=”MLA”]Texas Tech. “Alzheimer’s Manifests Differently in Hispanic People.” NeuroscienceNews. NeuroscienceNews, 26 September 2016.
<https://neurosciencenews.com/hispanic-depression-alzheimers-5130/>.[/cbtab][cbtab title=”APA”]Texas Tech. (2016, September 26). Alzheimer’s Manifests Differently in Hispanic People. NeuroscienceNews. Retrieved September 26, 2016 from https://neurosciencenews.com/hispanic-depression-alzheimers-5130/[/cbtab][cbtab title=”Chicago”]Texas Tech. “Alzheimer’s Manifests Differently in Hispanic People.” https://neurosciencenews.com/hispanic-depression-alzheimers-5130/ (accessed September 26, 2016).[/cbtab][/cbtabs]


Abstract

Cross-Ethnic Differences in the Severity of Neuropsychiatric Symptoms in Persons With Mild Cognitive Impairment and Alzheimer’s Disease

In this cross-sectional study, we examined the neuropsychiatric profile of mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Data were available on 875 controls, 339 MCI cases, and 975 AD participants. Surprisingly, differences in neuropsychiatric symptom (NPS) severity by ethnicity in subjects with AD, but not with MCI, were found. More so, in Hispanics with AD, a higher frequency in most of the individual NPI-Q symptom items of the scale was observed, except for apathy. After adjustment for clinical features, some individual NPI-Q symptoms also showed an association with Hispanic ethnicity in the control group that nearly reached statistical significance. There may be cross-ethnic differences in the neuropsychiatric presentation of AD in Hispanics versus non-Hispanic whites. Future studies are needed to clarify the etiology of these differences, and to assess the need for ethnicity-specific treatment and care-giving interventions.

“Cross-Ethnic Differences in the Severity of Neuropsychiatric Symptoms in Persons With Mild Cognitive Impairment and Alzheimer’s Disease” by Ricardo Salazar, M.D., Alok Kumar Dwivedi, Ph.D., and Donald R. Royall, M.D. in Journal of Neuropsychiatry and Clinical Neuroscience . Published online July 15 2016 doi:10.1176/appi.neuropsych.15120423

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