Original Study| Volume 22, ISSUE 2, P446-452, February 2021

Download started.


Dementia in People from Ethnic Minority Backgrounds: Disability, Functioning, and Pharmacotherapy at the Time of Diagnosis

Published:August 02, 2020DOI:



      Increasingly, older populations in the United Kingdom 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 among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis.


      Cross-sectional study of patient characteristics at the point of dementia diagnosis.

      Setting and Participants

      In total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015.


      Data were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record.


      Compared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant 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 higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups.

      Conclusions and Implications

      At dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with 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 optimize pathways into care and personalize assessment and management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • House of Commons All-Party Parliamentary Group on Dementia
        Dementia Does Not Discriminate.
        (Available at:) (Published 2013)
        • Mukadam N.
        • Lewis G.
        • Mueller C.
        • et al.
        Ethnic differences in cognition and age in people diagnosed with dementia: A study of electronic health records in two large mental healthcare providers.
        Int J Geriatr Psychiatry. 2019; 34: 504-510
        • Tuerk R.
        • Sauer J.
        Dementia in a black and minority ethnic population: Characteristics of presentation to an inner London memory service.
        BJ Psych Bull. 2015; 39: 162-166
        • Mukadam N.
        • Cooper C.
        • Livingston G.
        A systematic review of ethnicity and pathways to care in dementia.
        Int J Griatr Psychiatry. 2011; 26: 12-20
        • Mueller C.
        • Perera G.
        • Hayes R.D.
        • Shetty H.
        • Stewart R.
        Associations of acetylcholinesterase inhibitor treatment with reduced mortality in Alzheimer's disease: A retrospective survival analysis.
        Age Ageing. 2018; 47: 88-94
        • Cullum S.
        • Varghese C.
        • Coomarasamy C.
        • et al.
        Predictors of mortality in Maori, Pacific Island, and European patients diagnosed with dementia at a New Zealand Memory Service.
        Int J Geriatr Psychiatry. 2020; 35: 516-524
        • Jones M.E.
        • Petersen I.
        • Walters K.
        • et al.
        Differences in psychotropic drug prescribing between ethnic groups of people with dementia in the United Kingdom.
        Clin Epidemiol. 2020; 12: 61-71
        • Mansour R.
        • Tsamakis K.
        • Rizos E.
        • et al.
        Late-life depression in people from ethnic minority backgrounds: Differences in presentation and management.
        J Affect Disord. 2020; 264: 340-347
        • Perera G.
        • Broadbent M.
        • Callard F.
        • et al.
        Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource.
        BMJ Open. 2016; 6: e008721
        • World Health Organisation
        International Statistical Classifications of Diseases and Related Health Problems, Tenth Revision, Vol 2 Instruction Manual.
        World Health Organization, Geneva2010
        • Das-Munshi J.
        • Chang C.K.
        • Dutta R.
        • et al.
        Ethnicity and excess mortality in severe mental illness: a cohort study.
        Lancet Psychiatry. 2017; 4: 389-399
        • Noble M.
        • McLennan D.
        • Wilkinson K.
        • et al.
        The English indices of deprivation 2007.
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Burns A.
        • Beevor A.
        • Lelliott P.
        • et al.
        Health of the Nation Outcome Scales for elderly people (HoNOS 65+).
        Br J Psychiatry. 1999; 174: 424-427
        • Pirkis J.E.
        • Burgess P.M.
        • Kirk P.K.
        • et al.
        A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures.
        Health Qual Life Outcomes. 2005; 3: 76
        • Burns A.
        • Beevor A.
        • Lelliott P.
        • et al.
        Health of the Nation Outcome Scales for elderly people (HoNOS 65+). Glossary for HoNOS 65+ score sheet.
        Br J Psychiatry. 1999; 174: 435-438
        • Cai W.
        • Mueller C.
        • Shetty H.
        • Perera G.
        • Stewart R.
        Predictors of mortality in people with late-life depression: A retrospective cohort study.
        J Affect Disord. 2020; 266: 695-701
        • Mueller C.
        • Huntley J.
        • Stubbs B.
        • et al.
        Associations of neuropsychiatric symptoms and antidepressant prescription with survival in Alzheimer's Disease.
        J Am Med Dir Assoc. 2017; 18: 1076-1081
        • Mueller C.
        • Molokhia M.
        • Perera G.
        • et al.
        Polypharmacy in people with dementia: Associations with adverse health outcomes.
        Exp Gerontol. 2018; 106: 240-245
        • Oudshoorn C.G.M.
        • Buuren S.
        • Rijckevorsel J.L.A.
        Flexible multiple imputation by chained equations of the AVO-95 survey. Leiden, Netherlands: TNO Prevention and Health Leiden.
        • Rubin D.B.
        Multiple imputation for nonresponse in surveys. Vol 81, New York: John Wiley & Sons.
        • Gasevic D.
        • Ross E.S.
        • Lear S.A.
        Ethnic differences in cardiovascular disease risk factors: A systematic review of North American evidence.
        Can J Cardiol. 2015; 31: 1169-1179
        • Das-Munshi J.
        • Clark C.
        • Dewey M.E.
        • Leavey G.
        • Stansfeld S.A.
        • Prince M.J.
        Does childhood adversity account for poorer mental and physical health in second-generation Irish people living in Britain? Birth cohort study from Britain (NCDS).
        BMJ Open. 2013; 3 (e001335)
        • Tillin T.
        • Forouhi N.
        • Johnston D.G.
        • et al.
        Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: A UK population-based cross-sectional study.
        Diabetologia. 2005; 48: 649-656
        • Office for National Statistics (ONS)
        People living in deprived neighbourhoods.
        (Available at:) (Published 2018)
        • Giebel C.M.
        • Worden A.
        • Challis D.
        • et al.
        Age, memory loss and perceptions of dementia in South Asian ethnic minorities.
        Aging Ment Health. 2019; 23: 173-182
        • Williams E.D.
        • Tillin T.
        • Richards M.
        • et al.
        Depressive symptoms are doubled in older British South Asian and Black Caribbean people compared with Europeans: Associations with excess co-morbidity and socioeconomic disadvantage.
        Psychol Med. 2015; 45: 1861-1871
        • Qassem T.
        • Bebbington P.
        • Spiers N.
        • et al.
        Prevalence of psychosis in black ethnic minorities in Britain: Analysis based on three national surveys.
        Soc Psychiatry Psychiatr Epidemiol. 2015; 50: 1057-1064
        • Fearon P.
        • Kirkbride J.B.
        • Morgan C.
        • et al.
        Incidence of schizophrenia and other psychoses in ethnic minority groups: Results from the MRC AESOP Study.
        Psychol Med. 2006; 36: 1541-1550
        • Halvorsrud K.
        • Nazroo J.
        • Otis M.
        • et al.
        Ethnic inequalities in the incidence of diagnosis of severe mental illness in England: A systematic review and new meta-analyses for non-affective and affective psychoses.
        Soc Psychiatry Psychiatr Epidemiol. 2019; 54: 1311-1323
        • Das-Munshi J.
        • Becares L.
        • Boydell J.E.
        • et al.
        Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC).
        Br J Psychiatry. 2012; 201: 282-290
        • Pham T.M.
        • Petersen I.
        • Walters K.
        • et al.
        Trends in dementia diagnosis rates in UK ethnic groups: Analysis of UK primary care data.
        Clin Epidemiol. 2018; 10: 949-960
        • Cooper C.
        • Spiers N.
        • Livingston G.
        • et al.
        Ethnic inequalities in the use of health services for common mental disorders in England.
        Soc Psychiatry Psychiatr Epidemiol. 2013; 48: 685-692
        • Waitzfelder B.
        • Stewart C.
        • Coleman K.J.
        • et al.
        Treatment initiation for new episodes of depression in primary care settings.
        J Gen Intern Med. 2018; 33: 1283-1291
        • Marwaha S.
        • Livingston G.
        Stigma, racism or choice. Why do depressed ethnic elders avoid psychiatrists?.
        J Affect Disord. 2002; 72: 257-265
        • Page A.T.
        • Potter K.
        • Clifford R.
        • et al.
        Medication appropriateness tool for co-morbid health conditions in dementia: Consensus recommendations from a multidisciplinary expert panel.
        Intern Med J. 2016; 46: 1189-1197
        • Woodward M.C.
        Deprescribing: Achieving better health outcomes for older people through reducing medications.
        J Pharm Pract Res. 2003; 33: 323-328
        • Hanlon J.T.
        • Fillenbaum G.G.
        • Burchett B.
        • et al.
        Drug-use patterns among black and nonblack community-dwelling elderly.
        Ann Pharmacother. 1992; 26: 679-685
        • Ryan L.
        • Leavey G.
        • Golden A.
        • et al.
        Depression in Irish migrants living in London: Case-control study.
        Br J Psychiatry. 2006; 188: 560-566
        • Leavey G.
        • Rozmovits L.
        • Ryan L.
        • King M.
        Explanations of depression among Irish migrants in Britain.
        Soc Sci Med. 2007; 65: 231-244
        • Whitman I.R.
        • Agarwal V.
        • Nah G.
        • et al.
        Alcohol abuse and cardiac disease.
        J Am Coll Cardiol. 2017; 69: 13-24
        • Rao T.
        The role of community nursing in providing integrated care for older people with alcohol misuse.
        Br J Community Nurs. 2014; 19 (82‒84): 80
        • Royal College of Psychiatrists (RCPsych)
        Our Invisible Addicts (2nd edition, CR211).
        (Available at:) (Published 2018)
        • Rao R.
        • Schofield P.
        • Ashworth M.
        Alcohol use, socioeconomic deprivation and ethnicity in older people.
        BMJ Open. 2015; 5: e007525
        • Cooper C.
        • Tandy A.R.
        • Balamurali T.B.
        • Livingston G.
        A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research.
        Am J Geriatr Psychiatry. 2010; 18: 193-203
        • Bhopal R.
        Glossary of terms relating to ethnicity and race: For reflection and debate.
        J Epidemiol Community Health. 2004; 58: 441-445
        • Roche M.
        • Higgs P.
        • Aworinde J.
        • Cooper C.
        A review of qualitative research of perception and experiences of dementia among adults from black, African, and Caribbean background: what and whom are we researching? Gerontologist.
        • Livingston G.
        • Sommerlad A.
        • Orgeta V.
        • et al.
        Dementia prevention, intervention, and care.
        Lancet. 2017; 390: 2673-2734
        • Roche M.
        • Mukadam N.
        • Adelman S.
        • Livingston G.
        The IDEMCare Study-Improving Dementia Care in Black African and Caribbean Groups: A feasibility cluster randomised controlled trial.
        Int J Geriatr Psychiatry. 2018; 33: 1048-1056