Neuropathological Diagnoses of Demented Hispanic, Black, and Non-Hispanic White Decedents Seen at an Alzheimer’s Disease Center

Article type: Research Article

Authors: Filshtein, Teresa Jenica^{a; *; 1} | Dugger, Brittany N.^{b; *; 1} | Jin, Lee-Way^{b; c} | Olichney, John M.^d | Farias, Sarah T.^d | Carvajal-Carmona, Luis^e | Lott, Paul^f | Mungas, Dan^d | Reed, Bruce^g | Beckett, Laurel A.^h | DeCarli, Charles^{d; i}

Affiliations: [a] Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA | [b] Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA | [c] UC Davis MIND Institute, Sacramento, CA, USA | [d] Department of Neurology, University of California, Davis, Sacramento, CA, USA | [e] Department of Biochemistry and Molecular Medicine and Genome Center, University of California, Davis, Sacramento, CA, USA | [f] Genome Center, University of California, Davis, Sacramento, CA, USA | [g] Center for Scientific Review, Division of Neuroscience, Development and Aging, NIH, Bethesda, MD, USA | [h] Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Sacramento, CA, USA | [i] IDeA Laboratory, Center for Neuroscience, University of California, Davis, Sacramento, CA, USA

Correspondence: [*] Correspondence to: Teresa J. Filshtein, PhD, Department of Epidemiology and Biostatistics, 550 16^th Street, Mission Hall: Global Health & Clinical Sciences Building, 2^nd Floor, Box #0560, San Francisco, CA 94158, USA. Tel.: +1 860 803 4577; E-mail: teresa.filshtein@ucsf.edu and Brittany N. Dugger, PhD, Department of Pathology and Laboratory Medicine University of California, Davis, 4645 2^nd Ave., 3400 A Research Building III, Sacramento, CA 95817, USA. Tel.: +1 916 734 3855; E-mail: bndugger@ucdavis.edu.

Note: [1] These authors contributed equally to this work.

Abstract: Our nation is becoming increasingly diverse; however, few autopsy studies examine multiple ethnoracial groups, especially Hispanics. We examined differences in neuropathological diagnoses of 423 deceased participants with dementia from three ethnoracial groups (35 Black, 28 Hispanic, and 360 non-Hispanic White) evaluated at the University of California Davis Alzheimer’s Disease Center. We used novel applications of bootstrap resampling and logistic regression standardization to project neuropathological diagnostic rates for non-Hispanic Whites to minority sample characteristics to improve inference of findings. Alzheimer’s disease (AD) without significant cerebrovascular disease (CVD) or other dementia-related pathologies (AD (non-mixed)) was present in 15 Black (43%), 4 Hispanic (14%), and 156 (43%) non-Hispanic Whites. CVD sufficient to contribute to dementia was confirmed in 14 Black (40%), 15 Hispanic (54%), and 101 (28%) non-Hispanic White decedents. The observed CVD prevalence of 40% in Blacks exceeded the predicted 29% [95% CI: 22%-36%]. Despite being outside the 95% confidence interval, the difference between observed and predicted was not statistically significant after bootstrap testing. Conversely, for Hispanics, the observed proportion at 54% exceeded significantly the predicted prevalence of 24% from non-Hispanic Whites [95% CI: 16%-34%], avg. p = 0.008). An identical analysis using AD (non-mixed) as the outcome predicted AD (non-mixed) in Blacks averaging 41% [95% CI: 34%-48%], nearly equal to observed prevalence. For Hispanics, however, the observed proportion at 14%, was well below predictions (mean = 42%, 95% CI: 32%-53%], avg. p = 0.008). We conclude mixed diagnoses and CVD are more common in Hispanic and Black decedents than Non-Hispanic Whites with dementia in our cohort. The increased prevalence of vascular co-morbidity may be a potential opportunity to intervene more effectively in dementia treatment of those individuals.

Keywords: Alzheimer’s disease, autopsy, brain, cognitive aging, cohort studies, dementia, minority groups, neuropathology, vascular

DOI: 10.3233/JAD-180992

Journal: Journal of Alzheimer's Disease, vol. 68, no. 1, pp. 145-158, 2019