According to the Alzheimer’s Association, “While older Black Americans are twice as likely as older whites to have Alzheimer’s or another dementia, research hasn’t yet identified the cause. Higher rates of cardiovascular (heart and blood vessels) disease may play a role.”
Although Black Americans disproportionately suffer from the disease, we are likely to be diagnosed later. Furthermore, a 2021 Alzheimer’s Association survey found that “Among non-white caregivers, half or more say they have faced discrimination when navigating health care settings for their care recipient, with the top concern being that providers or staff do not listen to what they are saying because of their race, color, or ethnicity.”
Physicians can help improve care for Black patients and take proactive steps to provide earlier diagnoses.
Several experts share what providers can do to support better care planning for aging.
“Dementia is a broad category of disorders that involve a decline in cognition severe enough to interfere with daily life,” explains Kimberly Idoko, MD, board-certified neurologist and medical director at Everwell Neuro. “Alzheimer’s is the most common cause, one of many.”
Although the terms are often used interchangeably, Alzheimer’s disease and dementia are not the same thing. Dementia is an umbrella term that describes a severe decline in memory, thinking, and daily functioning.
According to Stephanie Smith, LCSW, ASW-G, C-ASWCM, Alzheimer’s accounts for roughly 60 to 80 percent of dementia cases. Different dementias have distinct causes and symptom patterns. Smith explains that “vascular dementia follows strokes and tends to decline in steps. Lewy body dementia involves visual hallucinations and movement changes. Frontotemporal dementia hits behavior and language before memory does.”
An Alzheimer’s diagnosis is rarely straightforward because no singular test can pinpoint it. “It involves cognitive assessments, medical history, neurological exams, and sometimes brain imaging or lab work,” says Smith, noting that these diagnostics often require a referral to a geriatric specialist or neurologist. Understanding these differences can take time, but they are necessary to help providers tailor care and set realistic treatment expectations.
“Racial disparities in dementia care result, perhaps, from some combination of reduced access to specialty care; financial constraints/underinsurance; and historical mistrust of the healthcare system leading to delay,” Dr. Idoko says.
She adds that early signs of dementia include:
For aging people who live independently, it can take time for family and friends to recognize the full extent of the problem.
Smith says cultural dynamics can also play out in patient care. She recalls working with a family in which an older African American woman attended appointments alone, while her adult children waited outside. “They wanted to respect her privacy,” she says. “That’s not negligence. It’s a cultural value the healthcare system was never designed to accommodate, and it cost that family months of care.”
Access to primary care is a widespread concern for Black patients, but a 2023 press release from the Radiological Society of North America also showed that Black patients were getting MRIs (brain scans) much later than their white peers. “The average age at imaging for cognitive impairment among the groups with Black patients was 72.5 years, compared with 67.8 years for white patients, 66.5 years for Hispanics, and 66.7 years for the Other group. Only 50.9 percent of Black patients underwent MRI testing for cognitive impairment, compared to 60 percent of white patients, 67 percent of Hispanics, and 68.2 percent in the other group,” reads the release.
For providers, this knowledge of diagnostic gaps should mean making early diagnostic referrals for signs of aging — including compounding issues such as vision and hearing loss — rather than waiting for patient-reported decline.
Similarly, clinicians should take a proactive approach to asking patients who else should be involved in conversations about cognitive health and whether a trusted caregiver can be informed about evaluation results.
“Fifty-five percent of Black Americans think that significant loss of cognitive abilities or memory is a natural part of aging rather than a disease,” according to the Alzheimer’s Association.
Smith says many families struggle to admit that their matriarch or patriarch is on cognitive decline — and a doctor’s visit won’t always reveal the severity. “A person can hold it together for a 20-minute appointment and be struggling significantly the rest of the week,” she says.
That disconnect between what clinicians observe during a brief office visit and what families witness at home can delay referrals and treatment.” However, the key to early diagnosis may lie in looking for other related health conditions. Diabetes, depression, stroke, heart or blood disease, and hearing loss are often correlated with Alzheimer’s disease, according to the Alzheimer’s Society.
Smith notes that hearing loss has emerged as an important and potentially modifiable dementia risk factor. She explains that evidence for hearing loss is stronger in recent dementia prevention research, and that treating hearing loss “could potentially reduce dementia cases by up to 7 percent.”
Earlier detection will not eliminate Alzheimer’s disease, but it can provide families with more time to plan, access treatment, and address modifiable risk factors. While privacy laws govern consent, physicians should encourage anyone suspected of cognitive decline to be accompanied by a trusted caregiver during every appointment. Physicians should partner with caregivers to ensure referrals and aftercare are completed, and that any necessary legal documentation or contingency plans are well discussed before an emergency occurs.
For providers caring for Black patients, recognizing the systemic barriers that contribute to delayed diagnosis–stigma, access to care, and provider location or availability– is one of the most important steps toward improving patient outcomes.
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