Alzheimer's in Black Americans: What Drives the Higher Risk, and What Helps
Older Black Americans are about twice as likely as older White Americans to have Alzheimer's or another dementia. Researchers still don't know exactly why. What they do know points to heart and blood vessel health, access to care and, to a smaller degree, genetics, and several of those are things families can act on.
The gap, in numbers
The Alzheimer's Association puts it plainly: older Black Americans are about twice as likely as older White Americans to have Alzheimer's or another dementia, and older Hispanic Americans about one and a half times as likely. The most detailed national breakdown comes from a CDC team that counted diagnoses in Medicare claims.
Share of Americans 65 and older diagnosed with Alzheimer's or a related dementia, by race and ethnicity
Medicare fee-for-service claims, 2014.
Show the data as a table
| Group | Share with a diagnosis |
|---|---|
| Black | 13.8% |
| Hispanic | 12.2% |
| Two or more races | 11.5% |
| White (non-Hispanic) | 10.3% |
| American Indian and Alaska Native | 9.1% |
| Asian and Pacific Islander | 8.4% |
The same CDC analysis estimated that about 5 million Americans aged 65 and older had one of these diagnoses in 2014, and projected that the number would reach about 13.9 million by 2060 as the population ages.
These are diagnosed cases. Because many people with dementia are never diagnosed, and diagnosis rates differ between groups, the real gap could be larger or smaller than the table shows.
Why the risk is higher
There's no single answer, and anyone who offers one is overselling. The research points to several overlapping causes.
Heart and blood vessel health
The Alzheimer's Association notes that higher rates of cardiovascular disease among Black Americans may play a role. High blood pressure and diabetes damage small blood vessels in the brain, and both are on the Lancet commission's list of changeable risk factors for dementia.
Health and money
The same Alzheimer's Association page points out that some studies find the racial differences disappear once researchers account for overall health and socioeconomic status. That's an important finding. It suggests much of the gap comes from conditions people live in and the care they can get, rather than anything fixed.
Access to care
Fewer diagnoses, later diagnoses and less treatment for risk factors all widen the gap over time.
Genes, to a smaller degree
Genetics play a part in every group, but the specific genes differ in weight. More on that below.
What the genetics research found
Most of the early Alzheimer's gene research was done in people of European ancestry. A 2013 study in JAMA pooled genetic data from African American participants and found that a variant in a gene called ABCA7 raised the odds of late-onset Alzheimer's by about 1.8 times. In the same group, the best-known risk gene, APOE e4, raised the odds by about 2.3 times.
How much two gene variants raised the odds of Alzheimer's in African Americans
Odds ratio compared with people without the variant. 1.0 would mean no extra risk.
Show the data as a table
| Variant | Odds ratio |
|---|---|
| APOE e4 variant | 2.31 |
| ABCA7 variant | 1.79 |
Two cautions. The authors said the finding needs replication before anyone uses it in a clinic. And no gene test tells you whether you'll get Alzheimer's. Most doctors don't recommend genetic testing for late-onset Alzheimer's in people without symptoms, and a result wouldn't change what you should do this year, which is look after blood pressure, blood sugar, hearing and activity.
How people see it, and the barriers
The Alzheimer's Association has surveyed Black Americans about dementia and care. A few of the answers explain why diagnosis often comes late.
Black Americans on Alzheimer's and dementia care
Share of Black Americans in the Alzheimer's Association's survey.
Show the data as a table
| Statement | Share |
|---|---|
| Know someone with Alzheimer's or dementia | 65% |
| Think major memory loss is a normal part of aging | 55% |
| Have faced discrimination while seeking care for someone with Alzheimer's | about half |
| Confident they can get culturally competent care | 48% |
| Say they are concerned about Alzheimer's | 35% |
| Say they face no barriers to excellent dementia care | 20% |
The 55% figure stands out. If serious memory loss is seen as just part of getting old, families wait, and the window for treating other causes and planning ahead gets shorter. Our guide to the warning signs of Alzheimer's lays out where ordinary forgetting ends.
Research needs more Black volunteers
Black Americans are underrepresented in Alzheimer's trials. The Alzheimer's Association links that to a history of exclusion from medical research and discrimination in care, including the Tuskegee syphilis study. The result is that treatments are often tested mostly in people who carry less of the disease burden.
If you're open to it, the Alzheimer's Association runs a free matching service called TrialMatch, for people with dementia, caregivers and healthy volunteers. Joining a study is a personal choice. Asking questions first is reasonable: who runs it, what it involves, what happens to your data.
What families can do now
| Step | Why it matters |
|---|---|
| Get blood pressure checked and treated | High blood pressure in midlife is linked with later cognitive decline, and treating it is one of the best-supported steps |
| Keep diabetes under control | Diabetes is a dementia risk factor and damages small blood vessels in the brain |
| Ask for a cognitive check at the Medicare wellness visit | It's covered, quick and creates a baseline |
| Treat hearing loss | Hearing loss is one of the 14 changeable risk factors in the Lancet commission's list |
| Stay active and connected | Exercise and social contact both appear on every major prevention list |
| Call the 24/7 helpline with questions | The Alzheimer's Association line is 800-272-3900 and it's free |
More on the habits themselves is in our guide to habits that protect the brain after 50, and the rest of our brain health guides cover caregiving and the warning signs.
Questions readers ask
Why are Black Americans more likely to get Alzheimer's?
The exact cause isn't known. Higher rates of high blood pressure, diabetes and heart disease, unequal access to care and some genetic differences all seem to contribute, and some studies find the gap shrinks once overall health and income are taken into account.
Is there a genetic test for Alzheimer's risk?
Tests for genes like APOE exist, but for late-onset Alzheimer's they can't tell you whether you will get the disease, and most doctors don't recommend them for people without symptoms.
Can lowering blood pressure reduce dementia risk?
In a large trial called SPRINT MIND, people who brought their systolic blood pressure below 120 had fewer cases of mild cognitive impairment than those treated to a goal of 140. Talk to your doctor about the right target for you.