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Alzheimer’s disease robs people of their memories and ability to live normally. There’s no cure for it. And according to a report released this week, Maryland has among the highest rates in the country.
Baltimore City and Prince George’s County, specifically, are in the Top 5 local jurisdictions for the disease, according to a study conducted for the Alzheimer’s Association.
The group says this study, the first at the county level, aims to help the public and public health officials understand the scope and direct resources, particularly to underserved communities.
“The goals are to raise awareness about the early warning signs that are often confused with normal aging, which we hope will lead to more conversations with health care providers and ultimately, an improvement in rates of early detection,” said Ilene Rosenthal, the association’s program director.
“We know historic health disparities and lack of access to health care has contributed to the higher prevalence among African Americans and Latinos, which also has the effect of delaying a diagnosis until much later in the course of the disease.”
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The study was conducted by a team led by Kumar Rajan, a professor at Rush Medical College in Chicago, using data collected as part of an ongoing study in that city plus federal statistics. The county data was released this week at an association conference in Amsterdam.
Disease experts say there may be several reasons for the prevalence in Maryland, and the East and Southeastern regions of the country in general. But demographics likely explain the numbers. Places with higher rates of seniors have higher rates of Alzheimer’s because age is a primary risk factor.
But places with the highest rates also have higher numbers of Black and Hispanic residents. The association says Black Americans are twice as likely to have Alzheimer’s or other forms of dementia as older white people. Older Hispanic people are about 1 1/2 times as likely to have the disease.
About 12.9% of those age 65 and older in Maryland have Alzheimer’s disease, the study found.
Baltimore’s rate was higher at 16.6%, on par with Miami-Dade County, Florida, and Bronx County, New York. Prince George’s County had the next highest rate at 16.1%.
The national average for people over age 65 is 10.7%, or 1 in 9 seniors. The number is expected to continue rising, the association reported.
Alzheimer’s is the most common type of dementia, which is an umbrella term for a series of symptoms. All told, there are about 5.5 million Americans with dementia diseases. The diseases are caused by a combination of genetics, environment and lifestyle, according to the association.
Jim Macgill, an assistant commissioner at the Baltimore City Health Department, said they have been working toward reducing all manner of health disparities for years, including Alzheimer’s. Though he said officials there were not aware of how high ranking the city and state were for Alzheimer’s.
The U.S. Centers for Disease Control and Prevention, for example, reports Maryland has among the lowest rates of mortality due to Alzheimer’s. Macgill and Rosenthal both suggested that could be due to accounting on state death certificates, which may list other causes of death such as falls, pneumonia or another chronic condition, rather than the Alzheimer’s. This may be especially true among Black and Hispanic people.
And a Johns Hopkins Medicine analysis published in the Journal of General Internal Medicine in 2018 found that many older adults with dementia were not diagnosed or they and their families were unaware of the diagnosis, suggesting shortcomings in detection and communication of dementia.
Macgill said he’d like to see more disease data, at the neighborhood level, as he suspects the higher rates will match the higher rates in some communities for hypertension and diabetes. Those are in the more disadvantaged neighborhoods, which have predominately Black and Hispanic populations.
This, Macgill said, is due to structural inequities in those neighborhoods. There’s less access to health care, quality food, opportunities for exercise and other contributors to well-being. Those chronic diseases are also risk factors for Alzheimer’s.
The department had already been working to get people better access to health care generally, and part of that was education about Alzheimer’s.
Workers also will begin more urgently working with the Alzheimer’s Association on outreach at senior centers and elsewhere in the city, helping people understand the warning signs, get connected to health care providers for a cognitive assessment and accept the diagnosis.
He said the effort is also to help get families connected to resources. There are in-home services from Medicaid, the federal-state health program for low-income residents, as well as support for caregivers and other programs for what “will be a hard journey,” Macgill said.
“I think this is a major public health issue,” Macgill said. “The more we can get it down to the local level where we are meeting people in their communities and getting the information out to them the better off we will be.”
Dr. Halima Amjad, a geriatrician with Johns Hopkins Medicine, said she’s often asked by families of those in a memory clinic where she works about prevention. She said living a healthy lifestyle and reducing the instance of heart disease, diabetes, obesity and other chronic conditions is most helpful. Reducing hearing loss and head injuries would also reduce risk.
Other factors are alcohol abuse, stress and depression — and controlling them, particularly early in life, would reduce risk. She said that often becomes more difficult in some disadvantaged communities.
Amjad said some medications also now on the market can slow the decline of Alzheimer’s patients, including Leqembi, though other potentially more effective treatments are expected to be approved. A question, she said, is will they work well in Black people and minority groups heavily affected but not necessarily widely included in the research.
Getting people properly diagnosed and informed remains a challenge, said Amjad, chair of an Alzheimer’s council for the state and an author of the analysis finding people are unaware of their condition. She said eventually, a blood test could ease the diagnostic process that now involves some level of expertise and will on the part of doctors.
But preventing Alzheimer’s would be best of all.
“Recently, I started advocating that primary care physicians potentially use the universal concern for developing dementia as a motivator to get people to engage in a healthy lifestyle,” Amjad said. “I’m cautiously optimistic this is the start to getting better Alzheimer’s drugs. But these aren’t the cure.”
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meredith@thebaltimorebanner.com
Meredith Cohn is a health and medicine reporter for The Baltimore Banner, covering the latest research, public health developments and other news. She has been covering the beat in Baltimore for more than two decades.
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