Skip to main content
Black Health logo Black Health
Neurology Last reviewed:

Alzheimer's Disease

Also known as: AD, Alzheimer Dementia, Senile Dementia of the Alzheimer Type

Reviewed by the Black Health editorial team Last reviewed

2x

the rate of Alzheimer's and other dementias in older Black Americans compared to older white Americans (Alzheimer's Association, 2024 Facts and Figures)

Overview

Alzheimer's disease is the most common form of dementia, and it does not affect every community equally. Older Black Americans are about twice as likely to develop Alzheimer's or other dementias as older white Americans, according to the Alzheimer's Association (Alzheimer's Association, 2024 Alzheimer's Disease Facts and Figures). Despite that higher risk, Black patients are diagnosed later, receive specialist care less often, and have been enrolled in Alzheimer's clinical trials at far lower rates. This page names the disparity plainly, gives you the evidence, and tells you what to do with it.

How Alzheimer's Disease affects Black patients

Older Black Americans carry roughly twice the burden of Alzheimer's and related dementias as older white Americans. The Alzheimer's Association's 2024 Facts and Figures report puts the prevalence at 21.3 percent among Black Americans age 70 and older. The 2024 report also documents that only 20 percent of Black Americans say they face no barriers to excellent dementia care, only 48 percent feel confident they can access culturally competent care, and half report experiencing discrimination while seeking care for a loved one with dementia.

Diagnosis comes late. Gianattasio and colleagues, publishing in Alzheimer's and Dementia: TRCI in 2019 (PubMed 31890853), found non-Hispanic Black patients had roughly twice the risk of underdiagnosed or missed dementia compared with non-Hispanic whites. Black beneficiaries are more likely than white beneficiaries to receive their first dementia diagnosis in an emergency room or skilled-nursing facility rather than primary care, meaning the disease has already advanced before the system catches up.

Treatment access lags too. A 2022 analysis in Alzheimer's and Dementia (PMC9402814) found Black and Hispanic patients were significantly less likely than white patients to initiate cholinesterase inhibitors or memantine after a dementia diagnosis, and less likely to stay on them. Referral to a neurologist narrows the gap, which points the finger at primary-care prescribing patterns and specialist access, not patient preference.

Vascular risk drives a chunk of the prevalence difference. Hypertension, type 2 diabetes, and stroke are more common and start earlier in Black adults, and each of those independently damages the small vessels of the brain. Most older Black adults who develop dementia have mixed pathology: Alzheimer plaques plus vascular injury.

The APOE-4 story is genuinely different in people of African ancestry. The Reiman/Logue group's 2022 PLOS Genetics paper identified a locus near APOE on chromosome 19q13.31 that substantially reduces APOE-4-driven Alzheimer's risk on African-ancestry haplotypes; the odds ratio for APOE-4 homozygotes drops from about 7 to about 2 when the protective variant is present. The textbook line that APOE-4 means the same thing in every population is wrong, and clinicians ordering genetic testing should know that.

Lecanemab (Leqembi) and donanemab (Kisunla), the new anti-amyloid antibodies approved for early Alzheimer's, have a representation problem. In the lecanemab CLARITY-AD trial, Black participants made up roughly 2 to 3 percent of enrollment, per published baseline data; donanemab's TRAILBLAZER-ALZ 2 trial enrolled approximately 4 percent Black participants in the US arm. The drugs require confirmed brain amyloid for eligibility, and screening data show Black candidates are far more likely to be screened out for not meeting the amyloid threshold, which raises an unresolved question about whether amyloid-targeting therapy works as well, or is even the right target, in Black patients whose dementia is more often mixed pathology.

The caregiver economy rests on Black women. The Family Caregiver Alliance and the Alzheimer's Association report that African-American dementia caregivers provide an average of about 20 hours of unpaid care per week, are more likely than white caregivers to live with the person they care for, and more than half are simultaneously caring for a child under 18 or another older relative.

Symptoms

The Alzheimer's Association teaches ten warning signs. Any one of them, especially if it is a change from how you or your relative used to be, is worth a doctor visit.

  • Memory loss that disrupts daily life: asking the same question over and over, forgetting recent conversations, leaning hard on sticky notes and family reminders for things you used to handle yourself.
  • Trouble planning or solving problems: losing track of monthly bills, following a recipe you have cooked for years, or keeping numbers straight.
  • Difficulty completing familiar tasks: getting lost driving to church, the grocery store, or work.
  • Confusion with time or place: losing track of dates, seasons, or how you got somewhere.
  • Trouble with visual images and spatial relationships: difficulty reading, judging distance, or recognizing your own face in the mirror.
  • New problems with words when speaking or writing: stopping in the middle of a sentence, calling things by the wrong name.
  • Misplacing things and losing the ability to retrace steps: putting the remote in the refrigerator, then accusing family of stealing.
  • Decreased or poor judgment: giving away large sums to a phone scammer, neglecting hygiene, dressing for the wrong weather.
  • Withdrawal from work, church, or social activity.
  • Changes in mood and personality: new suspicion, anxiety, depression, irritability, or fearfulness, especially outside the home.

When to see a doctor

Get evaluated when memory or thinking changes start interfering with daily function. Concrete triggers: getting lost in a neighborhood you know, missing medications repeatedly, mismanaging bills you have always handled, a noticeable shift in personality or judgment, or family members independently noticing the same things you do.

The 55 percent of Black Americans who, per the Alzheimer's Association's 2024 survey, believe significant memory loss is a normal part of aging are wrong, and that belief delays diagnosis. It is not normal. A workup early in the course is when you have the most treatment options, including the new anti-amyloid drugs, which only work in early disease. Sudden confusion, a fall with new disorientation, or rapid decline over weeks rather than years is not Alzheimer's pattern and warrants urgent evaluation for stroke, infection, medication effect, or delirium.

Screening

There is no universal population screening for Alzheimer's in asymptomatic adults. Medicare's Annual Wellness Visit, available yearly at no cost to beneficiaries, is required to include a cognitive impairment check. If anything is flagged, the visit can convert to a billable Cognitive Assessment and Care Plan Service, which CMS pays for separately.

The brief tools used at this stage are the Mini-Cog (a three-item recall plus a clock-drawing test, takes three minutes), the Montreal Cognitive Assessment (MoCA, 30 points, more sensitive to mild impairment), and less often the MMSE or SLUMS. None of these diagnoses Alzheimer's by itself. An abnormal screen should lead to a full evaluation: structured history with a family member present, neurological exam, blood work to rule out thyroid disease and B12 deficiency, MRI to look for stroke, atrophy, or vascular damage, and increasingly amyloid PET or a blood biomarker if a disease-modifying drug is being considered.

Collateral history from family is decisive. The person with early Alzheimer's often does not perceive their own deficits, or covers smoothly in a short office visit. A daughter, son, or spouse who can describe what has changed over the past one to two years gives the clinician information no cognitive test can replace.

Treatment overview

Treatment is symptomatic, disease-modifying in narrow cases, and heavily non-pharmacologic.

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) modestly improve or stabilize cognition and daily function in mild-to-moderate disease. Memantine, an NMDA-receptor antagonist, is added in moderate-to-severe disease. None of these stop progression. They buy function and time, often six to twelve months of measurable benefit. Black patients are prescribed these drugs at significantly lower rates than white patients with the same diagnosis, a gap that narrows when a neurologist is involved.

Lecanemab (Leqembi) and donanemab (Kisunla) are anti-amyloid monoclonal antibodies approved for mild cognitive impairment or mild dementia due to Alzheimer's with biomarker-confirmed amyloid. They slow decline by roughly 25 to 35 percent over 18 months in the pivotal trials. They are infused IV, require frequent MRI monitoring for ARIA (amyloid-related imaging abnormalities, which can include brain swelling and microhemorrhages), and the published trials enrolled very few Black participants, so subgroup efficacy and safety in Black patients are genuinely unknown. APOE-4 homozygotes have higher ARIA risk in the trial data.

Non-pharmacologic care does most of the work. Structured daily routine, environmental cues, treatment of hearing loss (a major modifiable risk factor), physical activity, social engagement, and aggressive control of blood pressure, diabetes, and cholesterol are all evidence-based. Behavioral symptoms (agitation, sleep disturbance, suspicion) should be approached first with non-drug strategies: identify triggers, simplify environment, address pain and constipation, adjust caregiver communication. Antipsychotics in dementia carry a black-box warning for increased mortality and should not be the first move.

Caregiver support is part of the treatment plan. Caregiver burnout predicts nursing-home placement of the patient more strongly than the patient's own disease severity.

Questions to ask your doctor

Bring this list to your next appointment.

  • Based on my cardiovascular risk factors, what is my dementia risk and when should I be screened?
  • What cognitive screening tool do you use, and how often should I have one?
  • Am I a candidate for any of the newer anti-amyloid therapies?
  • Are there Alzheimer's clinical trials I should know about that are actively recruiting Black participants?
  • What community resources or support groups are available for my family?

Find care for alzheimer's disease

Not sure where to start? Describe what you're experiencing and we'll help you find the right kind of care, including a neurology.

Find care

The numbers

  • Black participants diagnosed with Alzheimer's or related dementias showed greater cognitive impairment and more risk factors at the time of diagnosis than white participants, consistent with later-stage presentation. (NIH NIA, 2024)
  • In an analysis of 16 Alzheimer's clinical trials, Black participants made up a small fraction of enrollees. This research gap limits the generalizability of findings to Black patients.

What it is

Alzheimer's disease is a progressive brain disorder that destroys memory and thinking skills and, eventually, the ability to carry out everyday tasks. It accounts for 60 to 80 percent of dementia cases. The disease unfolds over years, often beginning with subtle short-term memory lapses before advancing to problems with language, reasoning, and self-care.

The underlying biology involves the accumulation of two abnormal protein structures in the brain: amyloid plaques (clumps between nerve cells) and tau tangles (twisted fibers inside nerve cells). These structures disrupt communication between brain cells and trigger cell death. The exact mechanisms driving their formation are still under active research.

Alzheimer's is not a normal part of aging. Most people over 65 do not develop dementia. Age is the largest known risk factor, but it is not the only one.

Why it shows up differently for Black patients

Several intersecting factors raise risk and delay care for Black adults:

Cardiovascular risk factors. Hypertension, diabetes, and obesity all elevate dementia risk, partly by damaging blood vessels that supply the brain. Black adults carry higher rates of all three conditions. A large body of research links cardiovascular health directly to dementia risk, and controlling these conditions in midlife appears to reduce that risk. (PMC: Alzheimer's Disease in African Americans, 2014)

Chronic stress and structural racism. Sustained exposure to discrimination and economic precarity drives physiological stress responses that affect brain health over decades. This is not a theory: research links perceived discrimination to accelerated cognitive aging. (HHS ASPE, Racial and Ethnic Disparities in Alzheimer's Disease)

Later and less frequent diagnosis. Structural barriers (lower rates of specialist access, implicit bias in clinical encounters, and lack of screening) mean Black patients are more likely to present with advanced disease before receiving a formal diagnosis. The 35% lower odds of diagnosis at first visit (NIA, 2024) is a care-system finding, not a patient behavior finding.

Genetic factors under study. The APOE e4 allele, a known Alzheimer's risk gene, appears in Black Americans at higher frequencies than in non-Hispanic whites, though its predictive relationship in Black populations has been inconsistent across studies. The ABCA7 gene, involved in cholesterol transport, has also been linked to increased risk in Black Americans in genome-wide studies. (PMC: Alzheimer's Disease in African Americans, 2014)

Underrepresentation in research. Most Alzheimer's clinical knowledge derives from studies conducted predominantly with non-Hispanic white participants. That limits clinicians' ability to apply findings to Black patients and leaves open questions about how disease mechanisms, biomarkers, and treatments perform across racial groups.

Treatment, plainly

There is no cure for Alzheimer's disease. The goal of treatment is to slow progression, manage symptoms, and support quality of life.

FDA-approved medications:

  • Cholinesterase inhibitors (donepezil, rivastigmine, galantamine): Approved for mild to moderate Alzheimer's; modestly slow symptom progression. Black adults receive these medications less often than white adults, which is a care-access gap, not a clinical contraindication. (PMC: Alzheimer's Disease in African Americans, 2014)
  • Memantine: Approved for moderate to severe disease; works through a different mechanism than cholinesterase inhibitors and is sometimes used in combination.
  • Lecanemab (Leqembi) and donanemab (Kisunla): Newer anti-amyloid antibody therapies approved in 2023-2024 for early Alzheimer's. They slow progression by reducing amyloid plaques in the brain. Eligibility requires confirmation of amyloid pathology. Serious side effects including brain swelling and bleeding (ARIA) require monitoring. Enrollment in the trials that supported approval was predominantly white; less is known about their efficacy and safety profile specifically in Black patients.

Non-drug strategies with evidence:

  • Managing blood pressure, blood sugar, and cholesterol reduces vascular contributions to cognitive decline.
  • Regular aerobic exercise has the strongest non-pharmacological evidence for reducing dementia risk.
  • Social engagement and cognitive activity are associated with lower risk in observational studies, though causality is difficult to establish.

Care planning. For any patient diagnosed with Alzheimer's, early engagement with a geriatric care manager, social worker, or Alzheimer's care specialist is recommended. The Alzheimer's Association 24/7 Helpline (800-272-3900) connects patients and caregivers to local resources, support groups, and clinical trial information.

When to seek evaluation

Contact a primary care physician or neurologist promptly if you or a family member experiences:

  • Repeated short-term memory lapses (forgetting recent conversations, asking the same questions)
  • Getting lost in familiar places
  • Problems finding words in conversation
  • Difficulty managing finances, medications, or daily routines
  • Significant personality or mood changes

These symptoms warrant evaluation. They do not confirm Alzheimer's, but they should not be dismissed as normal aging.

How to find care

The Alzheimer's Association also maintains a searchable care and support finder and a 24/7 helpline: 800-272-3900.

Sources

  1. Alzheimer's Association. 2024 Alzheimer's Disease Facts and Figures. https://www.alz.org/alzheimers-dementia/facts-figures
  1. National Institute on Aging. Data Shows Racial Disparities in Alzheimer's Disease Diagnosis Between Black and White Research Study Participants. 2024. https://www.nia.nih.gov/news/data-shows-racial-disparities-alzheimers-disease-diagnosis-between-black-and-white-research
  1. U.S. Department of Health and Human Services, ASPE. Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review. https://aspe.hhs.gov/reports/racial-ethnic-disparities-alzheimers-disease-literature-review-0
  1. Chin AL, Negash S, Hamilton R. Diversity and Disparity in Dementia: The Impact of Ethnoracial Differences in Alzheimer Disease. Alzheimer Disease and Associated Disorders. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4084964/
  1. Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in Dementia Incidence Between Six Racial and Ethnic Groups Over 14 Years. Alzheimer's and Dementia. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9543531/
  1. Synapticure. Black Americans Are Disproportionately Impacted by Dementia and Underrepresented in Dementia Trials. https://www.synapticure.com/blog/black-african-americans-disproportionately-impacted-by-dementia-alzheimers-and-underrepresented-in-dementia-trials

Was this helpful?

Your feedback shapes what we cover next.

Thanks for letting us know.

If you found this useful, sign up for our newsletter to get more like this.

Thanks. What was missing?

Optional. We read every response.

Thanks.

We use this to prioritize the next round of edits.

Medical disclaimer

This content is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

Share:
Find a Black doctor near you