Ethnic disparities in the treatment of dementia in veterans

To test for ethnic disparities in the evaluation and treatment of dementia.

We reviewed 1,401 charts of patients from 4 veteran clinics that routinely evaluate dementia patients. A total of 410 patients met criteria for dementia or mild cognitive impairment (MCI) and their charts were reviewed in detail.

Regarding their evaluation, laboratory and imaging testing did not differ between ethnic groups (p > 0.05). Depression screening was more common in African-American (AA) patients (p = 0.03). Significantly more Caucasian patients underwent neuropsychologic testing (p = 0.001). Regarding management, in a multivariate analysis, AA patients with Alzheimer's disease (AD) (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02-0.5) or 'all dementia types' (OR 0.6, 0.3-0.9) were significantly less likely to receive acetylcholinesterase inhibitors (CHEIs). Other independent predictors of CHEI use were age >or=71 years (OR 5.2, 2.8-9.6), a diagnosis of AD (OR 3.1, 1.6-6.3) or MCI (OR 0.3, 0.1-0.7), and if their evaluation included imaging (head CT or MRI; OR 1.9, 1.05-3.3).

AA patients underwent comparable evaluations for dementia and the percentage of CHEI-responsive diagnoses rendered was similar across ethnic groups. However, dementia management differed significantly: AAs were prescribed CHEIs at considerably reduced rates. The reasons for this great disparity warrant further investigation because it may produce significantly greater cognitive impairment and hence suffering amongst AA patients.