The Alzheimer’s disease (AD) “epidemic” affects the entire country, but states like Alabama, Georgia, Louisiana, Mississippi, and South Carolina are particularly hard-hit. People born in this region, known as the Deep South, have a 20–30% higher risk of developing AD or dementia caused by other factors. Through our studies, we are working to find ways to reduce or eliminate these disparities.
More than 20% of the U.S. African American population lives in the Deep South. Risk of late-onset AD is twice as high in African Americans. This is especially evident in the Deep South. Health conditions such as high blood pressure (hypertension), diabetes, obesity, and vascular disease are more common in this region. These conditions are also related to cognitive decline and risk of dementia and AD.
An important reason that we do not understand the causes of these disparities in AD and dementia is that African Americans are historically disadvantaged in most research studies. The U.S. population over age 55 is composed of approximately 10% African Americans, but few AD-related studies have reached this level of African American participation. Because of this, the new National Strategy for Recruitment and Participation in ADRD Clinical Research of the National Institute on Aging is focused on broad participation. Accordingly, a major goal of the UAB Alzheimer’s Disease Center is to ensure the involvement of a wide range of participants, with a significant focus on historically disadvantaged populations.
Other Related Health Conditions in the Deep South. The Deep South is also well known for other health conditions related to a higher risk for AD and dementia.
Cerebrovascular disease such as stroke or mini-stroke is widespread in a region called the “Stroke Belt” that overlaps the Deep South. Both Alzheimer’s and cerebrovascular disease are frequent in older adults and can be causes of cognitive decline.
Diabetes is also common in the Deep South, and the region is now labeled the “Diabetes Belt”. Symptoms such as insulin resistance and nerve damage overlap with Alzheimer’s suggesting that Alzheimer’s is a “type 3 diabetes”. Diabetes increases the risk of both cerebrovascular disease and Alzheimer’s but how these conditions affect each other remains unknown.
Obesity is yet another familiar health risk in the Deep South. There are close relationships between obesity, diabetes, vascular disease and Alzheimer’s. Dementia in old age is associated with obesity in middle age and is possibly related to inflammation in the body and the brain.
Addressing these Deep South disparities in Alzheimer’s disease and dementia is a major goal of the UAB Alzheimer’s Disease Center.