Black patients face delays in Alzheimer’s diagnosis

Black patients underwent medical imaging for cognitive impairment years later than white and Hispanic patients and were less frequently tested with MRI, according to research being presented this week at the annual meeting of the Radiological Society of North America (RSNA).

Previous studies have shown that Black patients are at increased risk of Alzheimer’s disease and other types of dementia. They are less likely to have a diagnosis and are diagnosed at a more advanced stage of disease compared to white patients.

Medical imaging—ideally with MRI—plays an increasingly important role in the diagnostic work-up of cognitive impairment. However, it is unknown how disparities in imaging access may lead to these delays in cognitive impairment diagnoses.

“If disparity in obtaining access to neuroimaging is one possible barrier that delays diagnosis, it is important to identify this and figure out possible solutions to benefit these patients and prevent a delayed diagnosis,” said study lead author Joshua Wibecan, M.D., radiology resident at Boston Medical Center in Boston, Massachusetts.

Drawing from four years of data, Dr. Wibecan and colleagues studied imaging disparities at their safety net academic medical center. A safety net medical center provides health care for people regardless of their insurance status or ability to pay.

The researchers identified all outpatient CTs of the head, CT angiographies of the head and MRI brain examinations performed for cognitive impairment. They obtained patient self-identified race from the Boston Medical Center Clinical Data Warehouse for Research.

Self-identified Black/African American patients were imaged for cognitive impairment at an older age and were less frequently imaged for cognitive impairment with MRI. While CT and MRI can both be useful in detection of cognitive impairment and dementia diagnoses, MRI provides much more detail about brain abnormalities.

The average age at imaging for cognitive impairment among the groups with Black patients was 72.5 years, compared with 67.8 years for white patients, 66.5 years for Hispanics and 66.7 years for the Other group. Only 50.9% of Black patients underwent MRI testing for cognitive impairment, compared to 60% of white patients, 67% of Hispanics and 68.2% in the Other group.

“Our study demonstrates two main findings,” Dr. Wibecan said. “First, Black patients who received MRI or CT for cognitive impairment were significantly older than patients from other races. Second, Black patients were significantly less likely to be imaged with MRI, the optimal type of imaging for cognitive impairment, as opposed to CT.”

Early imaging evaluation is important to identify treatable causes of cognitive impairment, such as tumors, bleeding or swelling within the brain. Additionally, new treatments have recently become available for Alzheimer’s disease that can potentially slow the rate of decline. Earlier diagnosis may, therefore, lead to early treatment and a longer period of better cognitive function.

“As treatment for Alzheimer’s Disease improves, it will be even more important to identify patients at early stages of disease for optimal treatment,” Dr. Wibecan said.

Further research is needed, Dr. Wibecan said, to understand why there was a significant difference in the types of imaging exams ordered for the workup of cognitive impairment across racial groups.

Chad W. Farris, M.D., Ph.D., neuroradiologist from Boston Medical Center and assistant professor of radiology at Boston University Chobanian & Avedisian School of Medicine, co-authored the study.

Summary for Review

The study presented at the Radiological Society of North America (RSNA) revealed concerning disparities in the timing and types of medical imaging used for cognitive impairment among different racial groups. Here are the key points from the study:

  1. Disparities in Timing: Black patients underwent medical imaging for cognitive impairment at an older age compared to white, Hispanic, and other racial groups. The average age for imaging among Black patients was 72.5 years, whereas it was lower for white, Hispanic, and other groups.
  2. Disparities in Imaging Type: Black patients were less frequently tested with MRI (Magnetic Resonance Imaging) compared to other racial groups. MRI provides more detailed information about brain abnormalities compared to CT scans (Computed Tomography), which are also used but offer less detail.
  3. Potential Impact of Disparities: Delayed imaging and less frequent use of MRI could result in delayed diagnoses and treatment for cognitive impairment. Early imaging is crucial in identifying treatable causes and initiating timely treatments, especially in diseases like Alzheimer’s.
  4. Significance of Early Diagnosis: Early detection of cognitive impairment can help in identifying treatable causes like tumors or bleeding in the brain and can facilitate the timely initiation of treatments. It’s particularly crucial in conditions like Alzheimer’s, where new treatments may slow the progression if administered early.
  5. Need for Further Research: The study highlights the need for more research to understand the reasons behind these disparities in imaging practices among different racial groups. Identifying the root causes can help in developing solutions to address these disparities and ensure equitable access to optimal healthcare.

The lead author, Dr. Joshua Wibecan, stressed the importance of identifying these disparities and finding solutions to benefit patients, especially those from marginalized communities. Collaborative efforts involving researchers, healthcare providers, and policymakers are essential to address these disparities and improve healthcare access and outcomes for all individuals, irrespective of their racial background.

Dr. Chad W. Farris, a co-author of the study, also emphasized the significance of early diagnosis, especially considering the advancements in treatments for diseases like Alzheimer’s.

Understanding and addressing healthcare disparities, particularly in access to crucial diagnostic tools like medical imaging, are crucial steps toward achieving equitable healthcare for all individuals.

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