Mental Health

Depression



Several studies have identified ethnic differences in treatment interventions between African American and white older adults.

A 2002 study by Rollman revealed that primary care physicians were less likely to counsel African American compared to white patients with depression, although these ethnic differences were not significant when the authors made adjustments for education and socio-economic status. Prescriptions of antidepressant medications have increased significantly over the past 15 years across the life cycle.

Blazer et al. (2005) found that African American older adults were less likely to take antidepressants and were less likely to receive newer antidepressants (serotonin reuptake inhibitors).

Dementia


Cognitive impairment in the elderly is an important cause of functional impairment and significantly reduces the quality of life among older adults. Cross-sectional studies have found higher prevalence of cognitive impairment and dementia in African Americans compared to whites. Proposed biological factors associated with increased vulnerability to dementia for African Americans are:

  • Exposure to environmental agents (e.g. lead or mercury)
  • Poor access to health care
  • Elevated rates of infection and malnutrition

Other proposed factors are:

  • Higher prevalence of vascular-related
    cognitive impairment
  • Lower educational attainment and literacy rates

Validity of Neuropsychological Testing Instruments

Though neuropsychological testing is pivotal to the diagnosis of dementia, many factors may affect the validity of the test instruments including:

  • The patient’s degree of acculturation
  • Ethnic differences in performance on cognitive tests
  • Measurement bias in the assessment instruments (Hargrave, 2006)

Neurocognitive research suggests that higher levels of education serve as a protective factor against cognitive decline (“cognitive reserve”) (Hargrave, 2006). Premorbid educational experiences are thought to increase the individual’s capacity to cope with advancing brain pathology, alter the clinical expression of dementia and influence the neurophysiological heterogeneity observed in dementia. (Alexander et al. 1997).

Several population-based studies in the area of ethnicity and dementia have shown:

  • The prevalence and incidence rates for dementia appear to be higher among blacks relative to non-Hispanic whites
  • Neuropsychiatric manifestations may show differential frequencies according to ethnicity
  • Cross-ethnic differences have been identified in terms of both the provision of care as well as the positive and negative psychological outcomes of family caregivers (Harwood, 2000)