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• Posted February 28, 2023

Black Patients With Dementia Are Less Likely to Get Appropriate Meds: Study

When Black patients struggle with dementia, they are less likely to receive helpful medications than their white peers, a new study warns.

Researchers looked at how often patients received one or more of five classes of medications commonly given to dementia patients living at home.

The study builds on prior research that has identified a racial gap in use of dementia medicine among patients who live in nursing homes or are being cared for in hospitals.

Lead author Dr. Alice Hawkins said the drugs in question are often critical to a patient's quality of life.

"Many of these medications can be imperative in improving the well-being of patients and their loved ones by making sure to address such issues as agitation, mood swings and other dementia-related neurobehavioral symptoms,"said Hawkins, chief neurology resident at the Icahn School of Medicine at Mount Sinai in New York City.

"[But] what we found,"she added, "was that Black patients had these medications as part of their outpatient medication list consistently less often than white patients."

But Hawkins stressed that the study relied solely on patient medical records, so that it wasn't possible to know, for example, if Black patients were prescribed meds less often or whether some could not afford to fill prescriptions they received.

The study focused on several types of dementia medicines. They include:

• drugs used to slow loss of memory and thinking difficulties (cholinesterase inhibitors, including donepezil or galantamine)
• drugs for related depression and anxiety (SSRIs, including escitalopram or fluoxetine)
• drugs to treat dementia-related psychosis (antipsychotics such as quetiapine or risperidone)
• drugs to address agitation and anxiety (benzodiazepines, including lorazepam and clonazepam)
• NMDA antagonists designed to improve mental clarity.

For the study, the researchers reviewed medication records among nearly 26,000 men and women seen at the Mount Sinai health system. Of this group, nearly 3,700 were Black people.

Across the board, Black patients were less likely to receive any of the dementia medications in question.

For example, while 30% of the white patients were taking a cholinesterase inhibitor, just 20% of Black patients were.

NMDA antagonist use was also more frequent among white patients (17%) than Black patients (10%).

In all, 40% of white patients were taking SSRIs, compared to 24% of Black patients. For antipsychotics, the difference was 22% of white folks versus 18% of Black folks. For benzodiazepines, figures were pegged at 37% for white patients versus 17.5% for Black patients.

"Disparities in the use of medications for the treatment of dementia have been noted in the literature, so sadly, these findings were not entirely unexpected,"Hawkins said.

Referrals to specialists may help narrow the gaps, researchers said.

When a Black patient obtained care from a neurology specialist, he or she was just as likely to be prescribed an NMDA or cholinesterase inhibitor as a white patient, the study found.

That, researchers said, suggests that quality-of-care differences -- such as access to appropriate doctors -- could play a role.

"Larger systemic forces such as systemic racism, quality of care, and provider bias are harder to pin down, though they all may be playing a role in perpetuating these inequities,"Hawkins said, adding that more research is needed to pinpoint all the factors underlying these disparities.

But simply doing more research is not enough, said Dr. Hyman Scott, an assistant clinical professor with the University of California, San Francisco's School of Medicine, who reviewed the findings.

"Of course, it's important to track what's going on,"he said. "If we don't know what's happening we can't intervene."

The fact that this is happening is nothing new, Scott said.

"Almost all of the scientific community's attention to this problem goes to documenting it -- that's what gets all the attention," he said. "And at some point we have to stop documenting and start responding."

This is a problem that affects not just dementia patients, but those with HIV or heart issues or any number of other medical problems, Scott said.

"It's happening across the entire spectrum of our health care system," he said. "But we have never had a systemic structured institutionalized and focused response."

The challenge going forward is for scientists and researchers to focus on solutions, Scott said.

"Are we going to end racism? No. But we can mitigate the impact that racism has on outcomes with policy and structure level changes that need to happen," he said. "That's our responsibility in the medical community."

The findings were released Feb. 26 and will be presented April 22-27 at a meeting of the American Academy of Neurology, in Boston and online. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

More information

There's more about race bias in medical care at The Commonwealth Fund.

SOURCES: Alice Hawkins, MD, chief resident, neurology, Mount Sinai West/Mount Sinai Beth Israel, Icahn School of Medicine, New York City; Hyman Scott, MD, MPH, assistant clinical professor, School of Medicine, University of California, San Francisco; presentation, American Academy of Neurology meeting, Boston and online, April 22-27, 2023