Neurology News

Racial Disparities Identified in Presentation of Frontotemporal Dementia

Among patients with frontotemporal dementia (FTD), racial disparities exist regarding severity, functional impairment, and neuropsychiatric symptoms, according to study findings published in JAMA Neurology

Racial differences have the potential to impact disease presentation in any form of dementia due to socioeconomic, cultural, and structural factors. While racial differences have been investigated in other neuropsychiatric conditions, there is limited information regarding disparities among patients with FTD. Researchers conducted an exploratory cross-sectional, retrospective study to identify potential racial disparities for individuals with FTD regarding severity, function, and neuropsychiatric symptoms.

The researchers collected data from the National Alzheimer’s Coordinating Center (NACC) from national US cancer research centers from June 2005 to August 2021.

Participants were diagnosed with a behavioral variant of FTD or primary progressive aphasia (PPA). The NACC Frontotemporal Lobar Degeneration-Modified Clinical Dementia Rating (FTLD-CDR) was used to determine dementia severity, with higher scores indicating worse severity. The race categories in the NACC were Asian, Black, and White. 

It remains to be determined if the disparities observed in Alzheimer’s Disease and other forms of dementia are the same as those in FTD.

Some exclusion criteria included participants who had a symptom duration that was 4 standard deviations (SD) above the average duration (>239.6 months) and races with limited data. In particular, the researchers excluded American Indian or Alaska Native (n=4), Native Hawaiian or other Pacific Islander (n=3), other (n=13), and unknown (n=24) races. 

Of the 44,359 participants screened, 2478 were included in the analysis, including 63 (2.5%) Black, 59 (2.4%) Asian, and 2356 (95.1%) White participants.

The average age at the first visit was 65.3 (SD, 9.4) and the average symptom duration at the time of the first visit was 67.5 months (SD, 35.6 months).

Black participants had a higher FTLD-CDR global (β, 0.64; standard error [SE], 0.24; P =.006) and FTLD-CDR shortness of breath (β, 1.21; SE, 0.57; P =.03) scores. Asian participants and White participants did not have significantly different FTLD-CDR scores.

Regarding neuropsychiatric symptoms, Black individuals had increased delusions (odds ratio [OR], 2.18; 95% CI, 1.15-3.93; P =.01), agitations (OR, 1.73; 95% CI, 1.03-2.93; P =.04), and depression (OR, 1.75; 95% CI, 1.05-2.92; P =.03). In addition, Black participants had an increased symptom severity for the same symptoms. 

Compared with White participants, Black participants were less likely to display apathy (OR, 0.54; 95% CI, 0.32-0.94; P =.03) and had a lower apathy severity (OR, 0.60; 95% CI, 0.37-1.00; P =.047). On the other hand, compared with White participants, Asian participants had a higher apathy (OR, 1.89; 95% CI, 1.09-3.78; P =.03).

In addition, when compared with White participants, Asian participants exhibited more nighttime behaviors (OR, 1.72; 95% CI, 1.01-2.91; P =.04), and increased appetite (OR, 1.99; 95% CI, 1.17-3.47; P =.01).

When compared with White participants, Black participants were more likely to have hypertension and Asian participants were more likely to have diabetes. Moreover, hypertension in Black participants was associated with increased depression (OR, 1.2; 95% CI, 1.01-1.43; P =.04) 

“It remains to be determined if the disparities observed in Alzheimer’s Disease and other forms of dementia are the same as those in FTD,” the researchers noted. “As FTD is rarer than AD, any disparities caused by decreased awareness of dementias or caused by decreased access to care might be more pronounced in FTD compared to AD.”

Study limitations include a small number of participants in minority communities, the FTLD-CDR being based on clinician interpretation, and the inability to determine longitudinal changes.