Risk Factors and Race in Alzheimer’s

There are several risk factors that we look for when we weigh an individual’s chances for getting Alzheimer’s.

There is that pesky gene (APOe-E4) that shows up in most Alzheimer’s, but not all, but we have come to believe that, while genes play a major role, there are several genes at play, not one, and other factors are equally important.

Head injury is one of those risk factors. You won’t like it but it is true: people who play a lot of soccer have a significantly higher risk of developing Alzheimer’s due to heading the ball and other collisions on the field. Boxers develop a form of dementia that is named for their sport, dementia pugilistica. Any head injury increases the likelihood of future Alzheimer’s Disease.

One whole segment of our population is more likely to get Alzheimer’s: African-Americans. This isn’t as big a puzzle as you might think. There isn’t — as far as we know now — a gene carried in African-Americans that makes them more likely candidates for Alzheimer’s; at least, not directly. Then why are they much more likely to get the disease? Culture and politics rear their ugly heads at this point.

African-Americans have made great strides forward in recent decades; no question. However, as a group, they are still less likely to have access to good health care (especially preventative care) and as a whole they tend to have less income. Because their funds are limited, they are likely to eat more fat and starch in their diet and that leads to obesity.

Obesity is a huge risk factor for Alzheimer’s Disease. I have heard snide remarks made about African-Americans by white people who judged them by their size and then — always out of earshot of the individual, of course — wondering aloud how they could afford to eat that much food if they were poor. I’ve heard comments made about what they purchased with food stamps, etc. that didn’t just border on unChristian and slanderous, they leapt the border into sinfulness.

Say it with me: fat is cheap. Go look at the dollar menu at McDonald’s, Wendy’s, or Burger King. Rent "Super Size Me" by Morgan Spurlock. When funds are limited and preventative health care information is limited, people go to fat and starch. Compare the price of five pounds of potatoes versus five pounds of steak. Now, compare five pounds of hamburger with five pounds of steak. Now, compare five pounds of chitterlings with five pounds of hamburger. Have we made our point? There are cultural issues at stake here, too. Some African-American micro-cultures will not accept what they see as a white, yuppie diet rich in vegetables and fruits. Some of them consider obesity to be a sign of beauty and strength ("Baby Got Back" anyone?).

But even if they wanted to eat better, that takes money and it takes time. There are many, many areas in our country where a black woman would have to catch two buses and travel for an hour to get to a store that sold fresh fruit and vegetables but there are three McDonald’s within six blocks of her apartment. Stores want to locate where people have extra money; they don’t want to build in a poor section of town, especially if that area is high crime.

Primarily because of weight, there is far more diabetes among African-Americans than there is in the white population (by ratio, not raw numbers). There may be a genetic predisposition towards both obesity and diabetes but that link is unproven at present.

Diabetes, along with obesity, are two of the largest risk factors for Alzheimer’s Disease. Put those two together and you almost always get the third highest risk factor: lack of exercise. With weight comes pain on the joints and pressure on the heart and lungs making most exercise difficult and painful. So…rheumatoid arthritis shows up and we find the biggest bogey-man of all in Alzheimer’s — inflammation.

By the year 2030, we expect 6.9 million African-Americans to enter the highest risk years for Alzheimer’s (65-85). With their high rates of diabetes, obesity, poor diets, and lack of exercise, we expect a higher percentage of them to need long term care than whites or Asians There are no figures on Hispanic populations.

Churches should play a role in discussing how to be good stewards of our money, bodies, diet, and time. I think churches from outside African-American communities should make solid, meaningful relationships with leaders inside those communities and offer help, guidance, funds, education… all in Jesus’ name. It would prevent countless thousands of tragedies if we could help our brothers and sisters avoid Alzheimer’s.

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