Pharmacological Treatment of Alzheimer's Disease: Effect of Race and Demographic Variables

Article type: Research Article

Authors: Hernandez, Santiago^a | McClendon, McKee J.^b | Zhou, Xiao-Hua Andrew^{c; d} | Sachs, Michael^d | Lerner, Alan J.^{b; e; f; *}

Affiliations: [a] Case Western Reserve University, School of Medicine, Cleveland, OH, USA | [b] University Memory and Cognition Center, Case Western Reserve University, Cleveland, OH, USA | [c] Department of Biostatistics School of Public Health and Community Medicine, Department of Psychiatry and Behavior Sciences School of Medicine University of Washington, Seattle, WA, USA | [d] HSR&D Center of Excellence, U.S. Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA | [e] Department of Neurology, Case Western Reserve University, Cleveland, OH, USA | [f] University Hospitals, Case Medical Center, Cleveland, OH, USA

Correspondence: [*] Corresponding author: Alan J. Lerner, MD, Memory and Cognition Center, 3619 Park East Drive #211, Beachwood, OH 44122, USA. Tel.: +1 216 464 6412; Fax: +1 216 464 6403; E-mail: alan.lerner@case.edu.

Abstract: Existing research shows differences in medication use for Alzheimer's disease (AD) based on demographics such as race, ethnicity, and geographical location. To determine individual and community characteristics associated with differences in acetylcholinesterase inhibitor (AChEI) and memantine use in AD, 3,049 AD subjects were drawn from 30 centers and evaluated using the Uniform data set (UDS). Cases were evaluated at the individual level within the context of 31 communities (one center encompassed two separate geographical regions). Multivariate analysis was used to determine the significance of individual variables on medication use. Compared to non-Hispanic Whites, Blacks were less likely to use AChEI and memantine with odds ratios (OR) of 0.59 (95% CI 0.46–0.76) and 0.43 (95% CI 0.32–0.57), respectively. Compared to non-Hispanic Whites, non-Black Hispanics were less likely to use memantine (OR = 0.69 (95% CI 0.49–0.98)). No association was found between the proportion of Blacks or non-Black Hispanics versus non-Hispanic Whites at an Alzheimer Disease Center and individual use of AChEI or memantine. Other significant variables include gender, age, marital status, dementia severity, source of referral, AChEI use, and education. Education and age somewhat mitigated disparity. Significant racial and ethnic differences in AChEI and memantine use exist at the individual level regardless of the racial and ethnic composition of the individual's community. Research and initiatives at the societal level may be an important consideration toward addressing these differences.

Keywords: Acetylcholinesterase inhibitor, Alzheimer's disease, disparity, ethnicity, memantine, race

DOI: 10.3233/JAD-2010-1269

Journal: Journal of Alzheimer's Disease, vol. 19, no. 2, pp. 665-672, 2010