The state of Maryland holds the top spot for the highest rate of Alzheimer’s disease in the United States, despite it faring better in obesity rates, household income and residents with health insurance.
The traditionally Democratic state nestled next to the nation’s capital has more than one in eight over people 65 years and older with the condition, compared to around one-in-10 nationally.
Maryland is also the only state to have two counties with the top-10 highest Alzheimer’s rates. Baltimore City was tied for first place with 16.6 percent of people older than 65 years old and Prince George’s County was fourth with 16.1 percent –
The findings were detailed in the first-ever report of Alzheimer’s rates at the county level published in The Journal of the Alzheimer’s Association.
Megeen White, a medical research champion for the Alzheimer’s Association’s Maryland chapter, said: ‘The study just confirms that, yes, that it is a health crisis in our community, we need to address it as such.’
Dr Kumar Rajan, author of the report, said prevalence of the disease in Maryland is due to a higher number of Black and Hispanic residents.
These minority groups may have elevated rates of the dementia, health experts say, because they have higher incidences of heart disease, diabetes and high blood pressure – all conditions that impact brain health.
Previous research has shown older Black Americans are twice as likely to have Alzheimer’s or other dementias than older whites and older Hispanics are about 1.5 times more likely to have the disease than their white counterparts due to confounding factors of comorbidities and social aspects, such as racism and discrimination.
Diabetes is more prevalent among Black Americans, at a rate of 12 percent, and among Hispanics at a rate of 11.8 percent. Among White Americans, the rate is 7.4 percent.
High blood pressure is also more common in Black Americans (56 percent) than white Americans (48 percent).
Of Baltimore City’s nearly 570,000 residents, 62.3 percent are Black, compared to the national average of 9.4 percent, and 6.3 percent are Hispanic, though the national average is higher at 8.8 percent.
And across Maryland the number of minorities is also higher than average. In the state, 31.7 percent of residents are Black and 11.5 percent are Hispanic.
New York was a close second to Maryland, with an Alzheimer’s prevalence of 12.7 percent. However, New York has a lower rate of minorities among its total population. Just under 18 percent of New Yorkers are Black and 19.7 percent are Hispanic.
New York’s Bronx County, which tied Baltimore with a 16.6 percent Alzheimer’s prevalence, had higher rates of minorities than the country average, but still less than those of Baltimore, with 30 percent of the population identifying as Black and 47 percent as Hispanic.
However, New York state did have a higher rate than Maryland of residents 65 years and older – 18.1 percent.
Health experts and Alzheimer’s specialists all agree the greatest risk factor of Alzheimer’s disease is age, and nearly 16 percent of people in Baltimore City are 65 years and older, compared to the national average of 12 percent. In Maryland, 17 percent of residents are 65 years and older.
Ms White added: ‘We need to ensure enough awareness, education and support for all involved, but especially for those over 65.’
In addition to coexisting medical conditions, the Alzheimer’s Association said the higher prevalence of Alzheimer’s among Blacks and Hispanics can likely be explained by health and social disparities, as well as the marginalization and discrimination of these groups in the United States, which has been deeply rooted in history.
The association highlighted structural racism, which influences housing, education, employment, safety and exposure to pollutants. It also influences access to health services, care and prevalence of other health problems.
Following a 2022 report by the association that looked at racism and dementia, Dr Adriana Perez, a nurse practitioner and professor of nursing at the University of Pennsylvania said: ‘The consistent and pervasive lack of resources, as well as social and environmental factors, lead to disparities in other health outcomes such as cardiovascular disease and diabetes, which increase the risk for Alzheimer’s and other dementias.’
And Dr Rev Miriam Burnett, medical director of the African Methodist Episcopal Church International Health Commission, echoed those sentiments: ‘These systemic disparities are related to less access to important health-protecting resources such as high-quality care and social networks that provide valuable health information and support.’
The cumulative stress these factors put on a person ‘may directly influence dementia risk’ among Black and Hispanic people, the association said.
Nearly 13 percent of residents 65 or older in Maryland have Alzheimer’s disease, compared to the national average of 10.7 percent
Most recently, Ms White acknowledged this stress: ‘[The] study found that most likely those both personal and systemic experiences of racism do increase an individual’s risk of Alzheimer’s or other dementia. That could be potentially due to the increased stress levels in the body.’
Dr Keith Vossel, the Alzheimer’s Disease Program Director in the department of neurology at the University of California Los Angeles, told DailyMail.com marginalized groups experience stress, violence, discrimination and racism. All of these life experiences can influence epigenetic changes.
While genetic changes alter genes, epigenetic changes affect gene expression. Epigenetic changes do not physically alter DNA, but rather alter the way a gene is expressed.
Dr Vossel said: ‘These experiences can be passed down generation to generation through epigenetic changes.’
Genetics also play a strong role in the risk of Alzheimer’s and in 2022, researchers identified 31 new genes that appear to affect processes that play a role in the disease.
Of the genes, one called APOE-e4 has the strongest impact on risk.
Everyone inherits one of three forms of the APOE gene from their parents – e2, e3 or e4 – and scientists discovered that having the e4 form of the APOE gene increases a person’s risk the most of developing the disease.
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People who inherit one copy of this gene have three times the risk and people who inherit two copies of e4 have an estimated eight- to 12-fold risk of developing the dementia. These people are also more likely to develop the disease at a younger age.
African Americans are more likely than other races to have this gene.
However, researchers stressed this is still a new discovery and there are other aspects that contribute more to an increased risk that need to be addressed.
Maryland has previously acknowledged the high rate of Alzheimer’s in the state, releasing a four-year plan to address the disease and passing a law to increase access to in-home care services for people with dementia.
The plan’s goals to address the ‘crisis’ include increasing public awareness, educating people about the disease, improving care quality, supporting family caregivers and promoting innovation through data and research.
Education and communication are two major hurdles to overcome with the minority population and healthcare community when it comes to Alzheimer’s diagnosis and treatment, Dr Vossel said.
While mistrust leads to a lack of communication, Dr Vossel said many people ask why there are no doctors ‘that look like them’ that work with dementia patients.
He added: ‘Unfortunately there aren’t enough neurologists and dementia specialists from underrepresented groups. Doctors need to be able to identify with their community.’
In addition to a lack of minority doctors, there is also a lack of access to doctors and healthcare facilities in general.
Dr Vossel has heard from the community that they have transportation issues getting to healthcare institutions and that large or prestigious institutions that provide dementia care are not in their neighborhood, severely limiting patients’ abilities to receive proper a timely diagnosis and treatment.
Addressing the high rates of dementia in minority populations will require a multi-faceted approach and Dr Vossel said it will require everything from establishing a stable educational system that meets the needs of all its students, developing measures to combat heart disease and diabetes, implementing dementia screenings at routine doctors visits and allowing for doctors to be reimbursed for those screenings.
