Elderly, community-dwelling blacks and Latinos who have moderate to severe dementia are more likely than similar whites to show dementia-related behaviors such as combativeness, wandering, or hallucinations, according to a study that was supported in part by the Agency for Healthcare Research and Quality (K02 HS00006). These behaviors are perhaps the most troubling aspect of dementia to caregivers, and minority caregivers appear to be affected more than white caregivers. Thus, as the aging minority population grows, it will be especially important to target caregiver education, in-home support, and resources to minority communities, suggests Kenneth E. Covinsky, M.D., M.P.H., of the University of California at San Francisco.
Dr. Covinsky and his colleagues calculated the prevalence of eight dementia-related behaviors as reported by caregivers among 5,090 white, 469 black, and 217 Latino Medicare patients enrolled in the Medicare Alzheimer's Disease Demonstration and Evaluation study at eight U.S. sites during the period 1989 to 1991. The eight behaviors assessed were: constantly restless, constantly talkative, seeing or hearing things that are not there, suspicious and accusative, episodes of unreasonable anger, combativeness, wandering, and waking the caregiver.
Overall, 92 percent of patients had at least one dementia-related behavior. Also, 61 percent of black and 57 percent of Latino patients were reported to have four or more dementia-related behaviors compared with 46 percent of white patients.
Blacks were 41 percent more likely than whites to be constantly talkative, 89 percent more likely to have hallucinations, 70 percent more likely to have episodes of unreasonable anger, 40 percent more likely to wander, and 33 percent more likely to wake their caregiver. Latinos were 49 percent more likely than whites to have hallucinations, and 59 percent more likely to have episodes of unreasonable anger, combativeness, or wandering. A possible explanation is that white patients with dementia and dementia-related behaviors are more likely to be institutionalized, leaving relatively more black and Latino patients with dementia-related behaviors residing in the community.
See "Ethnic differences in the prevalence and pattern of dementia-related behaviors," by Kaycee M. Sink, M.D., Dr. Covinsky, Robert Newcomer, Ph.D., and Kristine Yaffe, M.D., in the August 2004 Journal of the American Geriatrics Society 52, pp. 1277-1283.
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