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Dementia in people from ethnic minority backgrounds: Disability, functioning and pharmacotherapy at the time of diagnosis

Research output: Contribution to journalArticle

Konstantinos Tsamakis, Romayne Gadelrab, Mimi Wilson, Anne M. Bonnici-Mallia, Labib Hussain, Gayan Perera, Emmanouil Rizos, Jayati Das-Munshi, Robert Stewart, Christoph Mueller

Original languageEnglish
JournalJournal Of The American Medical Directors Association
Publication statusAccepted/In press - 7 Jun 2020

King's Authors

Abstract

Objectives: Increasingly, older populations in the UK and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia amongst ageing older adults. The current study aimed to compare ethnic group differences in symptom profile and pharmacotherapy at dementia diagnosis.
Design: Cross-sectional study of patient characteristics at the point of dementia diagnosis.
Setting and Participants: 12,154 patients age 65 years or older diagnosed with dementia in South London between 2007 and 2015.
Methods: Data were extracted from the Clinical Record Interactive Search (CRIS) system, which provides anonymised access to the electronic health records of a large mental health care provider in South London. Patients from ethnic minority backgrounds were compared to White British individuals on mental and physical wellbeing, as well as functional scales and medications prescribed at dementia diagnosis, and subtype of dementia documented anywhere in the record.
Results: Compared to White British patients: Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have antidepressant treatment prescribed; White Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had a higher odds of polypharmacy; vascular dementia diagnoses were more common in Black and Irish ethnic minority groups.
Conclusions and Implications: At dementia diagnosis, there are substantial differences in non-cognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared to the White British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimise pathways into care and personalise assessment and management.

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