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Neuropsychological test performance in African-American* and white patients with Alzheimer's disease

From the Duke University Medical Center (Drs. Welsh, Fillenbaum, Wilkinson, and Heyman), Durham, NC; the Mount Sinai School of Medicine (Dr. Mohs) and Columbia University (Dr. Stern), New York, NY; the University of Alabama-Birmingham (Dr. Harrell), Birmingham, AL; and the University of Washington (D. Beekly and S. Edland), Seattle, WA.
Supported by NIA AG06790 CERAD (Consortium to Establish a Registry for Alzheimer's Disease) study and AG05128 to the Bryan Alzheimer's Disease Research Center at Duke University Medical Center.
Presented in part at the annual meeting of the American Neurological Association, San Francisco, CA, October 1994.
Received November 28, 1994. Accepted in final form April 8, 1995.
Address correspondence and reprint requests to Dr. Kathleen Welsh, Bryan Alzheimer's Disease Research Center, Duke University Medical Center, 2200 West Main Street, Suite A-230, Durham, NC 27705.
*Although the term ``African-American'' has been used recently to refer to black Americans in order to emphasize cultural roots and deemphasize race, the term ``black'' has been used by researchers and notable black scholars in the literature on minority aging. To avoid confusion and for purposes of consistency, we use the term ``black'' throughout the text to refer to the African-American group.

Little information exists on the performance of black versus white patients with Alzheimer's disease on neuropsychological tests for dementia.In this study, we compared performance on the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) neuropsychological battery between white (n equals 830) and black (n equals 158) patients with Alzheimer's disease enrolled in the CERAD study at 23 university medical centers in the United States. The black patients were older, had fewer years of formal education, and were more impaired in their activities of daily living than were the white patients. After controlling for these characteristics and for duration of the disease and severity of dementia, there were differences in the performance of black and white patients on several of the cognitive measures. Black patients scored lower than whites on tests of visual naming and constructional praxis and on the Mini-Mental State Examination. There were no statistical differences in performance on tests of fluency and word list memory. These findings suggest that cultural or experiential differences may modify performance on specific neuropsychological tests. These factors, in addition to age and educational background, should be considered when interpreting performance on neuropsychological tests in elderly black patients with dementia.

NEUROLOGY 1995;45: 2207-2211

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