Differences in Neuropsychiatric Features in Black and White Individuals Diagnosed with Frontotemporal Degeneration

Abstract

Background: Neuropsychiatric symptoms are highly prevalent in frontotemporal degeneration (FTD). Prior research suggests there are disparities in the clinical presentation of dementia when comparing Black and White individuals but this has not been investigated in the context of FTD specifically. The aim of the present study is to investigate racial disparities in dementia severity, functional impairment and neuropsychiatric symptoms in individuals with a clinical diagnosis of FTD. Methods: Using National Alzheimers Coordinating Center (NACC) data, we evaluated 63 Black and 2,356 White individuals living with a clinical diagnosis of FTD (behavioral variant FTD or primary progressive aphasia) and a healthy control group of 1899 Black and 9122 White individuals with normal behavior and cognition. We compared demographic characteristics, dementia severity, functional impairment and neuropsychiatric symptoms at initial NACC visit by examining differences on Clinical Dementia Rating Scale (CDR), Functional Assessment Scale (FAS) and Neuropsychiatric Inventory (NPI) using multivariable linear and logistic regression models, covarying for age at visit, disease duration, sex, and education. Models evaluating differences in neuropsychiatric symptoms additionally controlled for dementia severity. Results: Black individuals with FTD were considerably underrepresented, comprising only 2.5 percent of the clincial sample. In comparison to White individuals, Black individuals with FTD had a higher degree of dementia severity on CDR (CDR sum of boxes; p=0.03 CDR global, p=.006), greater functional impairment (FAS total; p=0.01) and more delusions (p=0.01), agitation (p=0.04) and depression (p=0.03) on the NPI. White individuals with FTD were more likely to demonstrate apathy (p=0.03). Within the normal control group, Black individuals reported less depression, anxiety, agitation, and nighttime behaviors (depression; p < 0.001; anxiety; p = 0.006; agitation; p = 0.048; nighttime behaviors; p < 0.001) compared to White normal controls. Discussion: The present study suggests there are significant disparities in dementia severity, functional impairment and neuropsychiatric presentations at initial visit between Black and White individuals with FTD. Future work must address racial disparities in FTD and their underlying social determinants as well as the lack of representation of non-White individuals in nationally representative neurodegenerative disease registries in order identify appropriate interventions

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

ACKNOWLEDGEMENTS The NACC database is funded by NIA/NIH Grant U24 AG072122. NACC data are contributed by the NIA-funded ADRCs: P30 AG062429 (PI James Brewer, MD, PhD), P30 AG066468 (PI Oscar Lopez, MD), P30 AG062421 (PI Bradley Hyman, MD, PhD), P30 AG066509 (PI Thomas Grabowski, MD), P30 AG066514 (PI Mary Sano, PhD), P30 AG066530 (PI Helena Chui, MD), P30 AG066507 (PI Marilyn Albert, PhD), P30 AG066444 (PI John Morris, MD), P30 AG066518 (PI Jeffrey Kaye, MD), P30 AG066512 (PI Thomas Wisniewski, MD), P30 AG066462 (PI Scott Small, MD), P30 AG072979 (PI David Wolk, MD), P30 AG072972 (PI Charles DeCarli, MD), P30 AG072976 (PI Andrew Saykin, PsyD), P30 AG072975 (PI David Bennett, MD), P30 AG072978 (PI Neil Kowall, MD), P30 AG072977 (PI Robert Vassar, PhD), P30 AG066519 (PI Frank LaFerla, PhD), P30 AG062677 (PI Ronald Petersen, MD, PhD), P30 AG079280 (PI Eric Reiman, MD), P30 AG062422 (PI Gil Rabinovici, MD), P30 AG066511 (PI Allan Levey, MD, PhD), P30 AG072946 (PI Linda Van Eldik, PhD), P30 AG062715 (PI Sanjay Asthana, MD, FRCP), P30 AG072973 (PI Russell Swerdlow, MD), P30 AG066506 (PI Todd Golde, MD, PhD), P30 AG066508 (PI Stephen Strittmatter, MD, PhD), P30 AG066515 (PI Victor Henderson, MD, MS), P30 AG072947 (PI Suzanne Craft, PhD), P30 AG072931 (PI Henry Paulson, MD, PhD), P30 AG066546 (PI Sudha Seshadri, MD), P20 AG068024 (PI Erik Roberson, MD, PhD), P20 AG068053 (PI Justin Miller, PhD), P20 AG068077 (PI Gary Rosenberg, MD), P20 AG068082 (PI Angela Jefferson, PhD), P30 AG072958 (PI Heather Whitson, MD), P30 AG072959 (PI James Leverenz, MD).

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All contributing ADRCs are required to obtain informed consent from their participants or caregivers and study procedures are approved by local Instituitional Review Boards prior to submitting data to NACC.

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Yes

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Data Availability

Qualified researchers may obtain access to all de-identified data in the NACC registry used for this study (http://www.naccdata.org).

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