title: Impediments to timely diagnosis of Alzheimer's disease in African Americans.
abstract: The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.
authors.affiliation: Department of Adult and Elder Health, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA. pcclark@emory.edu
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Clark
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Kutner
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Goldstein
authors.forename: Susan
authors.initials: S
authors.lastname: Peterson-Hazen
authors.forename: Vanessa
authors.initials: V
authors.lastname: Garner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.forename: Tess
authors.initials: T
authors.lastname: Bowles
mesh_terms: D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000208:ethnology*; D000647:Amnesia / Q000175:diagnosis / Q000208:ethnology; D044383:Black People / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004522:Educational Status; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008511:Medicine; D008569:Memory Disorders / Q000175:diagnosis / Q000208:ethnology; D008609:Mental Status Schedule; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D013038:Specialization; D013997:Time Factors; D014505:Urban Population; D044465:White People / Q000523:psychology; D001741:Black or African American