The Alzheimer’s Association has identified anemerging public health crisis among African-Americans — the Silent Epidemic of Alzheimer’sDisease. This report brings together for the first timean accumulating body of evidence about the scopeand nature of Alzheimer’s disease in African-Americans. Each study is important on its own, butonly when put together does the magnitude of thecrisis become clear.Among the findings from research highlighted in thisreport : • Alzheimer’s disease is more prevalent amongAfrican-Americans than among whites — withestimates ranging from 14% to almost 100%higher;• There is a greater familial risk of Alzheimer’s inAfrican-Americans; and • Genetic and environmental factors may workdifferently to cause Alzheimer’s disease inAfrican-Americans.Scientists are at a vital juncture in research. Advancesin genetics and imaging, combined with our increasedunderstanding of the mechanisms of Alzheimer’s,provide immense opportunities to examine the diseasein African-Americans in ways that would not havebeen possible even five years ago. Without additionalinvestment in Alzheimer’s research targeted to allpopulations, but especially to African-Americans,there is a danger that research will be stopped in itstracks. The Promise of Vascular ResearchOne of the most promising areas of research whereadditional funding is needed is the growing body ofevidence that vascular disease may be a keymechanism in triggering the manifestation ofAlzheimer’s disease. Data from longitudinal studiessuggest that high cholesterol and high blood pressuremay be significant risk factors for Alzheimer’s. Theimplications of these discoveries are enormous forAfrican-Americans, among whom vascular disease andits risk factors are disproportionately present. Effectivetherapies for primary and secondary prevention ofvascular disease already exist – including cholesterol-lowering drugs (statins) and anti-hypertensivemedications. Now, observational studies indicate thatthese drugs may also protect against cognitiveimpairment and Alzheimer’s disease. This is a line ofscientific inquiry that must be pursued as aggressivelyas possible.The epidemic of Alzheimer’s will continue to spreadover the next 30 years, as the number of African-Americans entering the age of risk more than doublesto 6.9 million. There is no time to waste.1IntroductionCall To ActionThis report lays out a plan of action that will requirean unprecedented mobilization of public and privateresources on three fronts: First, to accelerate the research to understandAlzheimer’s in African-Americans and to developeffective methods to manage and prevent disease.Second, to increase awareness of Alzheimer’samong African-Americans, to expand theirparticipation in research and to get services andtreatments to those who are affected by thedisease.Third, to develop and expand affordable,culturally appropriate services, includingassessment, diagnosis, and care.African-Americans Are Hard Hit byAlzheimer’s Disease• Age-specific prevalence of dementia has beenfound to be 14% to 100% higher in African-Americans. (While the rates vary among studies,three out of four report these higher prevalencerates.) • The cumulative risk of dementia among first-degree relatives of African-Americans who haveAlzheimer’s disease is 43.7%. • For spouses (who share environmental but notgenetic backgrounds), the cumulative risk was18.4%. These findings of familial risk, reportedin January 2002, are based on family histories ofthe largest number of African-American familiesever studied for Alzheimer’s disease.The Number of African-Americans EnteringAge of Risk is Growing Rapidly• Age is a key risk factor for Alzheimer’s disease inall racial and ethnic groups. Over 10% of allpersons over 65, and nearly half of those over 85have Alzheimer’s disease.• The number of African-Americans age 65 andover will more than double by 2030, from 2.7million in 1995 to 6.9 million by 2030• The number of African-Americans age 85 andover is growing almost as rapidly, from 277,000in 1995 to 638,000 in 2030 and will increasemore than five-fold between 1995 and 2050,when it will reach 1.6 million.Genetic and environmental risk factors forAlzheimer’s disease seem different in African-Americans• Genetic risk factors seem different in African-Americans and white Americans. APOEgenotype alone does not explain the increasedfrequency of Alzheimer’s disease in older African-Americans.• Data from a large-scale longitudinal studyindicate that persons with a history of eitherhigh blood pressure or high cholesterollevels are twice as likely to get Alzheimer’sdisease. Those with both risk factors arefour times as likely to become demented.• Sixty-five percent of African-AmericanMedicare beneficiaries have hypertension,compared to 51% of white beneficiaries.They are also at higher risk of stroke. (Datafrom the Current Medicare BeneficiarySurvey)• African-Americans have a 60% higher riskof type 2 diabetes — a condition thatcontributes directly to vascular disease.• African-Americans have a higher rate ofvascular dementia than white Americans.Screening and assessment tools and clinicaltrials are not designed to address the uniquepresentation of Alzheimer’s disease in African-Americans• Ethnic and cultural bias in current screening andassessment tools is well documented. As a result,What the Research Shows2The prevalence, incidence, and cumulative risk ofAlzheimer’s disease appears to be much higher inAfrican-Americans than in non-Hispanic whites.Vascular disease may be a particularly powerful factorin the prevalence of Alzheimer’s among African-Americans.3As the largest private funder of Alzheimer research,the Alzheimer’s Association has invested nearly $120million to find answers to this disease. We areproviding research grants to encourage new African-American investigators and research on African-Americans at a number of institutions and areparticularly proud of our early investment in some ofthe most important research described in this report,including the longitudinal study of African-Americansand Nigerians at Indiana University. In 2002, aprimary focus of the research funded by theAssociation will be vascular disease and dementia. Wehave also formed a Diversity Work Group of leadingresearchers working on Alzheimer’s disease in diversecultures to help us identify priorities for