From the limited information available on Alzheimer's disease and related dementias across ethnic minority groups, this paper describes the prevalence of these diseases and how the cultural values and social conditions of a group influence family caregiving and use of formal services and interventions. This discussion emphasizes the importance of taking into account cultural and social factors (e.g., social class and education) in any examination of Alzheimer's disease and related dementias-includ ing how shared collective cultural values and beliefs provide a framework for experiences with dementing illnesses.
PREVALENCE OF DEMENTIA AND RISK FACTORS
While the prevalence of dementia in the United States is projected to nearly quadruple in the next fifty years, primarily as a result of increased longevity and population aging (Brookmeyer, Gray, and Kawas, 1998), current prevalence rates, upon which these projections are based, are not well established. This lack of information is especially true for ethnic minority groups. Table i shows a selection of regional studies often cited to indicate national prevalence, but the appropriateness of these limited studies in describing the general population is questionable, especially if race and ethnicity are to be taken into account.
For example, to our knowledge, there are no national prevalence data available to document rates of dementia even among whites, but a study by Evans and colleagues (1989) is often used to indicate national prevalence rates, even though the rates in this study were found using a predominantly Italian-American sample living in East Boston, Mass. Other studies in Table i that provide prevalence data only on Japanese Americans are often cited to indicate prevalence of dementia among Asian-Americans in general.
According to some studies (e.g., Hendrie et al., 1995), African Americans do appear to have a higher prevalence of Alzheimer's disease and related dementias than other ethnic minority groups. Some limited research on Native Americans suggests that they may have the lowest prevalence of dementia among ethnic minorities in the United States, but again, the studies are of questionable value. For example, Kramer (1996) cites two studies illustrating the incidence of dementia among Native Americans. One study examined discharge diagnoses from fortyone Indian Health Service hospitals, but it provided no indication that the patients whose discharges were being reviewed were ever evaluated for dementia. The other study examined a sample of192 Cree Indians in Manitoba, Canada. Its results can hardly be generalized to Indians across North America because of its small sample size and the isolation of this tribal group.
While prevalence data are indeed sketchy, a look at risk factors does suggest that some groups are at greater risk, for a variety of reasons. The strongest risk factor for Alzheimer's disease is age. There are also genetic risk factors, with specific and nonspecific genetic inheritance associated with one or more immediate family members having Alzheimees disease (see Epstein and Connor, this issue). Previous head trauma and lower levels of education are also considCerebrovascular dementia typically has risk factors in common with a stroke, including cardiovascular disease, hypertension, and diabetes (Ross, Petrovitch, and White, 1996). Some researchers (Garland et al., 1997) suggest that socioeconomic factors may place African Americans and Hispanics at higher risk of dementia as compared to whites. First, groups with lower socioeconomic status have a higher incidence of cardiovascular disease, hypertension, and diabetes, all of which are risk factors for cerebrovascular dementia. Second, lower educational and occupational attainments have been found to be associated with Alzheimer's disease, but the reasons for this association are not clear. For example, it could be that characteristics common among those with higher attainment delay clinical manifestations, or it could be that diagnostic techniques are more sensitive for those with characteristics common among those with lower attainment (Sten et al. …