鈥淥ur study shows that the severity and proportion of neuropsychiatric symptoms is significantly higher in a Hispanic group compared to non-Hispanic whites,鈥� says lead researcher Ricardo Salazar, M.D., a geriatric psychiatrist at (TTUHSC El Paso). 鈥淭his could have a significant impact on the treatment and understanding of how Alzheimer鈥檚 disease progresses in Hispanics.鈥�
Both cognitive and behavioral decline can occur with Alzheimer鈥檚 disease. Cognitive signs of the disease include memory loss and problems with orientation and physical functioning. Behavioral, or neuropsychiatric symptoms, include depression, elation, anxiety, hallucinations, delusions and apathy. These neuropsychiatric symptoms have been associated with higher rates of institutionalization and more rapid progression of the disease.
Curious to understand how neuropsychiatric symptoms manifest in Hispanics with dementia, Dr. Salazar and his team gathered data on more than 2,100 individuals in the (TARCC) database. Patients profiled in the database are predominantly non-Hispanic whites and Mexican-Americans who have been diagnosed with Alzheimer鈥檚 disease or mild cognitive impairment (MCI), or are otherwise healthy subjects. The team specifically focused on each individual鈥檚 (NPI-Q), an exam used to assess the extent of 12 neuropsychiatric symptoms.
A review of the data showed that during MCI 鈥� the intermediate state between healthy cognition and Alzheimer鈥檚 disease 鈥� all ethnicities were affected equally by neuropsychiatric symptoms. But once the condition had progressed to full-on Alzheimer鈥檚 disease, the severity of neuropsychiatric symptoms in Hispanics increased significantly.
Dr. Salazar believes these divergent symptoms may reflect a different disease process in Hispanics.
鈥淲hen patients have neuropsychiatric symptoms, that signifies deterioration of different areas of the brain,鈥� he explains. 鈥淚 believe functional imaging studies of the brain may show differences in the locations of amyloid or plaque collection in the brains of Hispanics with Alzheimer鈥檚 disease.鈥�
The JNCN study also showed that depression and anxiety were more frequent in healthy Hispanics age 50 years and older than in healthy, non-Hispanic whites of the same age. This corroborates past studies suggesting that depression may be one of the first signs of Alzheimer鈥檚 disease.
鈥淗ispanics tend to get Alzheimer鈥檚 disease at an earlier age than other [ethnic groups], and our study shows that these neuropsychiatric symptoms of depression and anxiety manifest earlier in them, too,鈥� Dr. Salazar says. 鈥淭his suggests that depression and anxiety in older Hispanics could be an early warning for Alzheimer鈥檚 disease鈥攁nd that treatment of these symptoms could even delay the disease.鈥�
As a geriatric psychiatrist in an overwhelmingly Hispanic region, Dr. Salazar has witnessed this phenomenon firsthand.
鈥淚 am a strong believer that if you use antidepressants to treat MCI that appears with symptoms of depression, you can slow the progression of Alzheimer鈥檚,鈥� he says. 鈥淢aybe even avoid full-on progression to the disease.鈥�
Dr. Salazar implores physicians to be aware that depression can mask dementia, particularly in the Hispanic population.
Dr. Salazar admits the study has limitations. Ethnicity was self-reported by individuals, and there were also fewer Hispanic participants with Alzheimer鈥檚 disease than white participants with the disease.
While additional research is clearly needed, Dr. Salazar鈥檚 study could be a window to how to better treat 鈥� and even prevent 鈥� Alzheimer鈥檚 disease in this rapidly-growing demographic.
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For a full copy of the paper, email [email protected]
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