Study: Black Patients Undergo Later, Less Frequent Imaging for Cognitive Decline

Black individuals underwent imaging for cognitive impairment years later and were less frequently tested with MRI compared with patients who are White or Hispanic, according to results of a study presented at the annual meeting of the Radiological Society of North America.¹

BillionPhotos.com - stock.adobe.com

In previous studies, investigators found that Black individuals have an increased risk of Alzheimer disease (AD) as well as other types of dementia. However, they are also less likely to be diagnosed and are more likely to be diagnosed at more advanced stages compared with those who are White, according to a press release. MRIs have an important role in diagnosing cognitive impairments, but it is unknown how disparities in the imaging access affects the delays in diagnosing.¹

“If disparity in obtaining access to neuroimaging is one possible barrier that delays diagnosis, it is important to identify this and figure out possible solutions to benefit these patients and prevent a delayed diagnosis,” Joshua Wibecan, MD, radiology resident at Boston Medical Center in Boston, Massachusetts, said in a press release.¹

Using 4 years of data, Wibecan and colleagues studies imaging disparities at their “safety net” medical center, which provides health care for all patients, regardless of insurance or ability to pay. The investigators identified outpatient computed tomographies (CTs) of the head, CT angiographies of the head, and MRI brain examinations to determine cognitive impairment. They used information from patients who self-identified race from the Boston Medical Center Clinical Data Warehouse for Research.¹

Investigators of the study found that individuals who self-identified as Black were less frequently imaged for cognitive impairment with MRI and at an older age, averaging at 72.5 years compared with 67.8 years for those who were White, 66.5 years for those who were Hispanic, and 66.7 years for all other groups. They said that while CT and MRI are useful at detecting cognitive impairment, MRIs can provide more details on brain abnormalities, according to the press release.

According to the results, approximately 50.9% of Black individuals underwent MRI testing compared with 60% of White patients, 67% of Hispanic patients, and 68.2% for those in other groups.¹

“Our study demonstrates 2 main findings,” Wibecan said in the statement. “First, Black patients who received MRI or CT for cognitive impairment were significantly older than patients from other races. Second, Black patients were significantly less likely to be imaged with MRI, the optimal type of imaging for cognitive impairment, as opposed to CT.”¹

Wibecan stated that it is important to identify patients early for optimal treatment of AD and other dementias.¹ A session at the Academy of Managed Care Pharmacy Nexus 2023 conference noted that approximately 96% of physicians feel that it’s important to assess patients aged 60 years and older for cognitive impairments; however, only 48% of patients did not have assessments from their physicians.² Aducanumab (Aduhelm; Biogen), lencanemab (Lequembi; Biogen, Eisai), and donanemab (Eli Lily) are all monoclonal antibodies that were studied for mild cognitive impairment and mild AD. The medications are used to reduce cognitive decline, making early identification of patients crucial to slow cognitive decline.²

Investigators stated that further research is needed to determine why there was a significant difference in imaging type across racial groups, according to the press release.¹

References

1. Black patients face delays in Alzheimer’s diagnosis. News release. EurekAlert. November 27, 2023. Accessed December 11, 2023. https://www.eurekalert.org/news-releases/1008661
2. Gallagher, A. Experts Highlight Need for Increased Screening for Dementia, Alzheimer Disease. Pharmacy Times. October 19, 2023. Accessed December 11, 2023. https://www.pharmacytimes.com/view/experts-highlight-need-for-increased-screening-for-dementia-alzheimer-disease