Black people are receiving medications for dementia less often than white people, according to a preliminary study published this month.
A new study has highlighted the racial disparities in dementia care among patients in nursing homes and hospital settings.
Researchers behind the study, which was supported by the American Academy of Neurology, looked at how often participants received one or more of five medication classes typically prescribed for dementia.
These included cholinesterase inhibitors, which prevent the breakdown of a chemical messenger in the brain called acetylcholine, which is important for memory and thought, and N-methyl-D-aspartate (NMDA) antagonists, which can help cognitive function. Both drug classes help facilitate communication between nerve cells.
Dementia patients are also often prescribed common antidepressants, selective serotonin reuptake inhibitors (SSRIs), antipsychotics to treat psychosis and benzodiazepines which can be used to treat anxiety and agitation.
The study involved 25,930 people, of this group, 3,655 were Black and 12,885 were white.
Researchers collected information on the participants including asking them about race and outpatient medications.
They found that Black people with dementia received all five medication types less often than white people.
For cholinesterase inhibitors, 20 per cent of Black people received a prescription compared to 30 per cent of white people.
For NMDA antagonists, the numbers were 10 per cent for Black people and 17 per cent for white people.
For SSRIs, the numbers were 24 per cent and 40 per cent. For antipsychotics, the numbers were 18 per cent and 22 per cent. For benzodiazepines, the numbers were 18 per cent and 37 per cent.
The differences remained after researchers controlled for factors such as age, sex, and insurance type.
Alice Hawkins, MD, of Mount Sinai in New York, New York, and a member of the American Academy of Neurology, said: “Previous research has shown that due to racial disparities, people with dementia do not always receive the same access to medications that may be beneficial in nursing homes and hospitals.
“However, there is limited data for the use of dementia medications that people take at home. Our study found disparities in this area as well. We hope our findings lead to a better understanding of these disparities so that steps can be taken to eliminate this health inequity.”
She continued: “Black people who saw a neurologist were receiving cholinesterase inhibitors and NMDA antagonists at rates more comparable to white people.
“Therefore, referrals to specialists such as neurologists may decrease the disparities for these prescriptions.”
A limitation of the study was that the data relied on what was present in participants’ medical records. Another limitation is that data on the actual prescription behavior of physicians could not be reliably collected.
Dr Hawkins said it remains unclear how much of the observed disparity is due to physicians prescribing fewer medications to Black people versus other patient-related factors, such as inability to afford medications.
Dr Hawkins noted: “More research is needed to understand the root cause of such disparities and design programs to eliminate them.”
The findings will be presented at the American Academy of Neurology’s 75th Annual Meeting which takes place in Boston and online, from April 22-27, 2023.
