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Weaving the old with the new

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Dementia and Alzheimer’s disease are so closely related to the obesity and diabetes that already runs rampant among Native Americans that the whole process of indigenous cognitive decline is starting to be referred to as Diabetes III, a new category.

“Native Americans in Arizona have the highest rate of diabetes of any tribal entities in the U.S. and, according to Indian Health Service statistics, the incidence of the disease doubled in the adult American Indian/Alaskan Native population from 1980 – 2005,” said Dr. Michael Trujillo, a member of New Mexico’s Laguna Pueblo and former IHS director who now supervises health research for the Inter-Tribal Council of Arizona.

“The incidence of diabetes in the AI/AN population skyrocketed in the decade from 1994 – 2004, increasing 58 percent (actually, 120 percent from years 1980 – 2005 with nearly 16 million now affected and nearly 40 percent of those being senior citizens). And those numbers are expected to continue to rise upward. Center for Disease Control statistics show a continuing rise of people with a BMI (Body Mass Index) greater than 30 or about 30 pounds overweight for a 5-foot-4-inch person. Correspondingly, we’re observing a higher rate of dementia and Alzheimer’s disease in individuals who are obese and suffer from diabetes, and that portends a tremendous impact on both families and tribes.”

At a recent Tucson conference on Alzheimer’s and dementia in Native Americans – Banner Alzheimer’s Institute’s Weaving the Old with the New – some 300 attendees listened to a panel of experts note that the maladies now affect 5.3 million Americans along with family caregivers – at an annual cost of $148 billion – and those numbers were expected to increase as the population ages.

The Alzheimer’s Association has issued an ominous outlook: “By 2030, when our entire baby boom generation is over 65, the number of Americans with Alzheimer’s will soar to levels that may exceed our ability to absorb the added cost. (Interestingly, the International Psychogeriatrics Association reports that the age of onset in Native Americans was two years later [71.7 years] than the age of onset in non-Natives in its study). Many experts are convinced that ongoing research may soon clarify aspects or risk that individuals may be able to influence through lifestyle changes – a strategy that may delay the onset of Alzheimer’s by five years and halve the number of affected individuals over the next 50 years.”

“Up until fairly recently, if you ask most indigenous cultures, they didn’t even have a word in their language to describe these diseases because there was some acceptance that as you age common symptoms were a normal part of aging,” said Banner Physicians Assistant Helle Brand.

With no scientific background to compare family traits, behavioral aberrations in the elderly were accepted as a part of the process of getting older. “Although the medical community first diagnosed these specific problems over a century ago and we used terms like ‘senile dementia,’ ‘organic brain syndrome,’ or ‘hardening of the arteries,’ it wasn’t until the late 1970s that we started to do some serious research and are now beginning to arrive at a better understanding of what we’re dealing with.”

Some of that research is ongoing in Phoenix at the Banner Alzheimer’s Foundation. “We’ve been engaged in a small scale study, working with a small group for the past several years, to follow Native Americans and identify just exactly what risk factors we’re dealing with,” Brand said. “Just what is the percentage of Native Americans that actually develop Alzheimer’s? Is it the same as most other cultures? Higher? We don’t really know yet and one of our jobs is to find that out.”

Trujillo alluded to known risk factors for cognitive decline in his conference presentation. “You can’t do much about how old you are, your gender, or what kind of genetics your mom and pop may have bequeathed you, but under the medical factors category, you do have some input on things like hypertension, heart disease, and cholesterol counts. … and you definitely can work on diabetes/obesity issues.”

Conferences like this are part of an educational outreach effort on what can be done. “These workshops provide informational tools to better educate the Native American population on diagnosis and treatment of the diseases, day-to-day living, nutrition and exercise,” Banner said.