Older Native Americans may experience higher levels of cognitive impairment than previously thought

Researchers have found that 54% of older Native Americans have cognitive impairment, including 10% with dementia, highlighting a significant disparity with the rates of cognitive impairment and dementia in the general American population. The study also identified vascular injury, which can result from untreated hypertension and diabetes, and Alzheimer’s disease as equally responsible contributors to dementia in Native Americans, with substantial overlaps between the two.

The findings were published in Alzheimer’s & Dementia.

“These results underscore that cognitive impairment among elder American Indians is highly prevalent, more than previously thought,” said Amy S. Kelley, M.D., deputy director of NIH’s National Institute on Aging (NIA). “Considering how these new prevalence figures for American Indians are much higher than other groups, as we continue to pursue prevention strategies and treatments, it is imperative that we address health disparities to help us find solutions that will work for all older adults.”

Previous studies that relied on medical records estimated that cognitive impairment and dementia levels in Native Americans were similar to non-Hispanic whites. However, for this new study, the researchers used survey and screening techniques with individual assessments that did not rely on previous access to the medical care system.

They found that 216 Native American participants aged 72–95 had some form of impairment. Of those, 140, or 35.3%, of them had mild cognitive impairment (MCI), 41 (10.3%) had dementia, and 35 (8.8%) had a different form of cognitive impairment that was not due to MCI or dementia. There were 181 (45.6%) participants who showed no signs of cognitive impairment.

These results suggest the levels of MCI and dementia in Native Americans who are 72–95 years of age are higher than those in other groups. Based on previous studies, researchers estimated MCI levels at 12% to 21% of non-Hispanic whites, 22% to 25% of Black Americans, and 20% to 28% of Hispanics/Latinos. Vascular brain injury measures were seen more often than Alzheimer’s markers in the MCI cases, suggesting that both Alzheimer’s disease and vascular brain injury may have been drivers of cognitive impairment for many of the participants.

“This research also suggests that vascular risk factors, such as hypertension and diabetes, are known to be modifiable and therefore could be prioritized to potentially reduce the risk of cognitive impairment among American Indians,” said Dallas Anderson, Ph.D., M.P.H., an NIA program director and neuroepidemiologist.