Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Earlier Alzheimer Onset in Latino Persons: Ethnic Difference vs Selection Bias

Earlier Alzheimer Onset in Latino Persons: Ethnic Difference vs Selection Bias We found the observation of an earlier onset of Alzheimer disease symptoms in persons of Latino descent described by Clark et al1 a step forward in the characterization of the burden of dementia in this growing segment of the US population. However, we also feel that the group studied may have idiosyncrasies that limit the generalizability of this finding to the wider US Latino population. It is possible that older persons of Latino descent with memory loss are less likely to be brought to tertiary centers because their problems may be considered an inevitable consequence of aging. Although we don’t know of any studies that directly address differences in this form of “ageism” between Latino people and white people, it is known that Latino people use nursing facilities less frequently.2 A study of Mexican American individuals in Texas suggested that such persons tend to view the caregiving experience as an expression of family values; they may have a distrust for “culturally alien institutions”3 and therefore avoid bringing older persons with memory problems to a tertiary center for assessment. There might then be a bias in such a population for younger persons with memory problems, who are still the family breadwinners, to be preferentially brought to medical attention. Another possible confounder is the possibility of an over-representation of autosomal-dominant cases due to presenilin-1 mutations in Latino patients presenting to the centers participating in this study. Although there is no reason to believe that this form of the disease is more common in Latino people overall, 2 separate founder mutations in the presenilin-1 gene, 2 in Caribbean Hispanic people4 and 1 in persons of Mexican origin,5 have been reported in relation to some of the institutions participating in the study of Clark et al. Although these cases are unlikely to represent a high proportion of the subjects in this study, a few cases with ages at onset in the 30s and 40s as occurs with presenilin-1 mutations would significantly lower the mean age at onset in the Latino group. The authors did not indicate whether or not such cases were excluded in this study. Despite these confounders that can be difficult to control for, we feel that the study of Clark et al on the age at onset of the symptoms of Alzheimer disease provokes important discussion and study of ethnic differences in dementia. Back to top Article Information Correspondence: Dr Ringman, Alzheimer’s Disease Center, Department of Neurology, University of California, Los Angeles, 710 Westwood Plaza, Suite 2-238, Los Angeles, CA 90095-1769 (jringman@mednet.ucla.edu). References 1. Clark CMDeCarli CMungas D et al. Earlier onset of Alzheimer disease symptoms in Latino individuals compared with Anglo individuals. Arch Neurol 2005;62774- 778PubMedGoogle ScholarCrossref 2. Crist JD Mexican American elders' use of skilled home care nursing services. Public Health Nurs 2002;19366- 376PubMedGoogle ScholarCrossref 3. John RResendiz RDe Vargas LW Beyond familism: familism as explicit motive for eldercare among Mexican American caregivers. J Cross Cult Gerontol 1997;12145- 162PubMedGoogle ScholarCrossref 4. Athan ESWilliamson JCiappa A et al. A founder mutation in presenilin 1 causing early-onset Alzheimer disease in unrelated Caribbean Hispanic families. JAMA 2001;2862257- 2263PubMedGoogle ScholarCrossref 5. Murrell JRFaber KAlonso ME et al. The A431E presenilin 1 gene mutation associated with familial Alzheimer’s disease in individuals of Mexican descent: evidence for a founder effect [abstract]. J Neuropathol Exper Neurol 2003;62543Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Earlier Alzheimer Onset in Latino Persons: Ethnic Difference vs Selection Bias

Archives of Neurology , Volume 62 (11) – Nov 1, 2005

Loading next page...
 
/lp/american-medical-association/earlier-alzheimer-onset-in-latino-persons-ethnic-difference-vs-ntFkA75kNC
Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.62.11.1786-c
Publisher site
See Article on Publisher Site

Abstract

We found the observation of an earlier onset of Alzheimer disease symptoms in persons of Latino descent described by Clark et al1 a step forward in the characterization of the burden of dementia in this growing segment of the US population. However, we also feel that the group studied may have idiosyncrasies that limit the generalizability of this finding to the wider US Latino population. It is possible that older persons of Latino descent with memory loss are less likely to be brought to tertiary centers because their problems may be considered an inevitable consequence of aging. Although we don’t know of any studies that directly address differences in this form of “ageism” between Latino people and white people, it is known that Latino people use nursing facilities less frequently.2 A study of Mexican American individuals in Texas suggested that such persons tend to view the caregiving experience as an expression of family values; they may have a distrust for “culturally alien institutions”3 and therefore avoid bringing older persons with memory problems to a tertiary center for assessment. There might then be a bias in such a population for younger persons with memory problems, who are still the family breadwinners, to be preferentially brought to medical attention. Another possible confounder is the possibility of an over-representation of autosomal-dominant cases due to presenilin-1 mutations in Latino patients presenting to the centers participating in this study. Although there is no reason to believe that this form of the disease is more common in Latino people overall, 2 separate founder mutations in the presenilin-1 gene, 2 in Caribbean Hispanic people4 and 1 in persons of Mexican origin,5 have been reported in relation to some of the institutions participating in the study of Clark et al. Although these cases are unlikely to represent a high proportion of the subjects in this study, a few cases with ages at onset in the 30s and 40s as occurs with presenilin-1 mutations would significantly lower the mean age at onset in the Latino group. The authors did not indicate whether or not such cases were excluded in this study. Despite these confounders that can be difficult to control for, we feel that the study of Clark et al on the age at onset of the symptoms of Alzheimer disease provokes important discussion and study of ethnic differences in dementia. Back to top Article Information Correspondence: Dr Ringman, Alzheimer’s Disease Center, Department of Neurology, University of California, Los Angeles, 710 Westwood Plaza, Suite 2-238, Los Angeles, CA 90095-1769 (jringman@mednet.ucla.edu). References 1. Clark CMDeCarli CMungas D et al. Earlier onset of Alzheimer disease symptoms in Latino individuals compared with Anglo individuals. Arch Neurol 2005;62774- 778PubMedGoogle ScholarCrossref 2. Crist JD Mexican American elders' use of skilled home care nursing services. Public Health Nurs 2002;19366- 376PubMedGoogle ScholarCrossref 3. John RResendiz RDe Vargas LW Beyond familism: familism as explicit motive for eldercare among Mexican American caregivers. J Cross Cult Gerontol 1997;12145- 162PubMedGoogle ScholarCrossref 4. Athan ESWilliamson JCiappa A et al. A founder mutation in presenilin 1 causing early-onset Alzheimer disease in unrelated Caribbean Hispanic families. JAMA 2001;2862257- 2263PubMedGoogle ScholarCrossref 5. Murrell JRFaber KAlonso ME et al. The A431E presenilin 1 gene mutation associated with familial Alzheimer’s disease in individuals of Mexican descent: evidence for a founder effect [abstract]. J Neuropathol Exper Neurol 2003;62543Google Scholar

Journal

Archives of NeurologyAmerican Medical Association

Published: Nov 1, 2005

Keywords: alzheimer's disease,hispanics or latinos

References