In Starr County, Texas, located near the state’s southern tip along the U.S.-Mexico border, dementia “affects about one in five adults on Medicare—more than double the national rate.” Why? There are a dozen risk factors for the disease that include everything from smoking and high blood pressure to air pollution, low education, and poverty. These tend to come in clusters and many of these combinations are present among the predominantly Hispanic Americans who call the community home.
In general, research shows that Hispanic people tend to live longer than non-Hispanic white people, despite facing higher rates of chronic disease and steeper socioeconomic disadvantages—a pattern sometimes called the “Hispanic paradox.” And in the Rio Grande Valley, part of what might sustain people through dementia, Maestre suspects, is the culture: Dementia is seen less as a medical emergency and more as a natural, if difficult, phase of life. Elsewhere, people with dementia may live in nursing homes or take expensive new Alzheimer’s drugs with modest benefit. In Starr County, many older adults remain at home, surrounded by family who offer familiarity and stimulation. The care is physical, intimate—not clinical, but constant—and backed by research showing that familiar environments and home-based care can enhance both quality of life and cognitive function for people with dementia.
Hispanic Americans face a significantly higher risk of dementia than white Americans, and are also one of the country’s fastest-aging groups. And yet, for decades, scientific understanding of dementia has drawn from data from mostly white, urban, and affluent populations; Hispanics make up fewer than 5 percent of participants in Alzheimer’s clinical trials. That limits researchers’ understanding of the condition. And the more they look, the less dementia seems like a single disease with a uniform pattern, and the more it appears to be a spectrum of diseases—each unfolding with its own course of symptoms, progression, and brain damage.
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