Mexican American Adults More Likely to Be Unaware of Dementia Diagnosis

Unawareness of a dementia diagnosis is high among Mexican American vs non-Hispanic White individuals with probable dementia, according to the findings of a study published in the Journal of General Internal Medicine.

Researchers conducted a population-based cohort study in Nueces County, Texas, to quantify dementia diagnosis unawareness and to evaluate how family caregiver burden can vary by ethnicity. Participants aged 65 and older were recruited from the Brain Attack Surveillance in Corpus Christi (BASIC) Cognitive study. Most members of the Hispanic/Latino community in the region are nonimmigrants with Mexican ancestry. Participants were enrolled in dyads of 1 patient and 1 caregiver from May 2018 through April 2023.

The researchers assessed cognitive function using the Montreal Cognitive Assessment (MoCA); participants with scores below 20 were classified as having probable dementia. Caregiver burden was measured using the 22-point Zarit Burden scale; participant’s degree of impairment was assessed with the Blessed Part 2 scale.

Participants were classified as being unaware of dementia diagnosis if they had probable dementia and neither the participant nor the caregiver was previously told by a doctor that the participant had dementia. Dementia diagnosis unawareness was measured using a participant self-report, a caregiver report, and a combined report. The Rao-Scott adaptation of the Pearson chi-squared test was employed for statistical analysis.

A total of 1562 participants met the inclusion criteria, with 322 categorized as having probable dementia (median age, 76 years [IQR, 70-83]; women, 55%; Hispanic race/ethnicity, 70%; median MoCA score, 15 [IQR, 10-17]). For the combined report, 80% of those with probable dementia reported that they were not previously diagnosed; this was more common in Mexican American individuals when compared with non-Hispanic White individuals (84% vs 65%; P ≤.001).

A total of 84% of the caregivers reported no prior dementia diagnosis for their partner, with more caregivers of Mexican American individuals (88%) reporting no prior diagnosis when compared with caregivers of non-Hispanic White individuals (88% vs 71%; P ≤ .001).

According to the participant self-report, 88% of those with probable dementia reported no prior dementia diagnosis, with a higher percentage of Mexican American individuals reporting no prior diagnosis vs non-Hispanic White individuals (91% vs 79%; P =.0011). Similar results were observed when using a stricter MoCA cutoff of less than 15 points; the overall rate of dementia diagnosis unawareness was 65% using the stricter cutoff.

After adjusting for age, sex, and marital status, dementia diagnosis unawareness was more likely in Mexican American vs non-Hispanic White individuals regardless of whether Mexican American individuals had graduated high school (odds ratio [OR], 2.65; 95% CI, 1.42-4.95) or did not graduate high school (OR, 2.80; 95% CI, 1.18-6.61).

Of the individuals with probable dementia, only 6.7% (Mexican American, 6.9%; Non-Hispanic White, 6.5%) did not have a routine place or physician for health care. No association was observed between the lack of primary care access and dementia diagnosis unawareness. No association was observed between caregiver-reported dementia diagnosis unawareness and greater caregiver burden, but lower MoCA score (incidence rate ratio [IRR], 0.98; 95% CI, 0.96-1.00) and greater participant physical impairment (IRR, 1.06; 95% CI, 1.03-1.10) were associated with caregiver burden.

Study limitations included a cross-sectional design nested within a cohort study, and self-reported data.

“Broad unawareness of dementia diagnoses, particularly with notable ethnic disparities, holds important implications for providers. Physicians may not engage in conversations with patients and families about dementia, most commonly due to a lack of training and time,” the researchers concluded.