More Alzheimer’s Risk Factors for Hispanics, Studies Suggest

By PAM BELLUCK
PHILADELPHIA — Antonio Vasquez was just 60 when Alzheimer’s disease derailed him.

He lost his job at a Queens bakery because he kept burning chocolate chip cookies, forgetting he had put them in the oven. Then he got lost going to job interviews, walking his neighborhood in circles.

Teresa Mojica of Philadelphia was 59 when she got Alzheimer’s, making her so argumentative and delusional that she sometimes hits her husband. And Ida J. Lawrence was 57 when she started misplacing things and making mistakes in her Boston dental school job.

Besides being young Alzheimer’s patients — most Americans who develop it are at least 65, and it becomes more common among people in their 70s or 80s — the three are Hispanic, a group that Alzheimer’s doctors are increasingly concerned about, and not just because it is the country’s largest, fastest-growing minority.

Studies suggest that many Hispanics may have more risk factors for developing dementia than other groups, and a significant number appear to be getting Alzheimer’s earlier. And surveys indicate that Latinos, less likely to see doctors because of financial and language barriers, more often mistake dementia symptoms for normal aging, delaying diagnosis.

“This is the tip of the iceberg of a huge public health challenge,” said Yanira L. Cruz, president of the National Hispanic Council on Aging. “We really need to do more research in this population to really understand why is it that we’re developing these conditions much earlier.”

It is not that Hispanics are more genetically predisposed to Alzheimer’s, say experts, who say the diversity of ethnicities that make up Hispanics or Latinos make a genetic explanation unlikely.

Rather, experts say several factors, many linked to low income or cultural dislocation, may put Hispanics at greater risk for dementia, including higher rates of diabetes, obesity, cardiovascular disease, stroke and possibly hypertension.

Less education may make Hispanic immigrants more vulnerable to those medical conditions and to dementia because scientists say education may increase the brain’s plasticity or ability to compensate for symptoms. And some researchers cite as risk factors stress from financial hardship or cultural adjustment.

The Alzheimer’s Association says that about 200,000 Latinos in the United States have Alzheimer’s, but that, by 2050, based on Census Bureau figures and a study of Alzheimer’s prevalence, the number could reach 1.3 million. (It predicts that the general population of Alzheimer’s patients will grow to 16 million by 2050, from 5 million now.)

“We are concerned that the Latino population may have the highest amount of risk factors and prevalence, in comparison to the other cultures,” said Maria Carrillo, the group’s director of medical and scientific relations.

In response, Alzheimer’s and Hispanic organizations have started health fairs and support groups. Some Alzheimer’s centers have opened clinics in Latino neighborhoods.

“There’s some taboos” about Alzheimer’s, said Liany Arroyo, director of the Institute for Hispanic Health at the National Council of La Raza, which surveyed Latinos. “Folks did not necessarily understand what it was.”

Antonia Lopez, who immigrated from Panama to Boston, showed symptoms at about 60, but it was 10 years before the family acknowledged it was Alzheimer’s, said her daughter, Carol Franklin.

“My mom was telling people, in her confusion, that I spanked her,” she said. “My brother believed that. He said to me at one point, ‘Don’t say that my mom has Alzheimer’s, because I believe it’s just part of being old.’ ”

Overwhelmingly, Hispanics with Alzheimer’s live with multigenerational families instead of in nursing homes. That support can be beneficial, experts say, but it severely stresses families.

When Maria Contreras, a Salvadoran immigrant, began wandering and hallucinating, her daughter, Teresa Navas, took her into her home in Silver Spring, Md. The strain on Ms. Navas and her children compelled her to place her mother in a nursing home, but when she kept getting sick, Ms. Navas took her home again and quit her job teaching Spanish.

“I have to be with her all the time,” she said. “Sometimes she doesn’t even know who I am.”

Mr. Vasquez’s daughter, Ana, 39, moved her parents to her Philadelphia home. She works at a neighborhood grocery and tells her sons, 6 and 11, “Watch out for your grandfather.”

Once, Mr. Vasquez was found hitchhiking on a major Philadelphia street. On a visit to the Bronx neighborhood where he had lived, he wandered away, leaving his family frenetically searching subway stations. “I was desperate, crying, especially when the night was coming,” said his wife, also named Ana.

Nine hours later, he appeared on their Philadelphia porch, having happened upon a bus to Philadelphia and given the driver a card with their address.

Scientists are searching for what sets Latinos apart. Dr. Rafael A. Lantigua, a professor of clinical medicine at Columbia University Medical School, said, “There’s no gene at this point that we can say this is just for Latinos.” Dr. Lantigua added that one gene that increased Alzheimer’s risk was less prevalent in Latinos than non-Hispanic whites.

Kala M. Mehta, an assistant professor in the geriatrics division at the University of California, San Francisco, analyzed autopsies from 3,000 Alzheimer’s patients, finding “similar neuropathology” among Latinos, whites and African-Americans.

And Mary Sano, director of the Alzheimer’s Disease Research Center at the Mount Sinai School of Medicine, found that different ethnic groups shared the most common behavioral symptoms, like repeating sentences and uncooperativeness.

But researchers say they have seen disparities in the timing of the illness and its severity when diagnosed.

Dr. Steven E. Arnold, director of the Penn Memory Center at the University of Pennsylvania, studied 2,000 white, African-American and Latino Alzheimer’s patients.

Dr. Arnold found that the Latinos, mostly low-income, poorly educated Puerto Ricans, many with diabetes, “have more depression,” and their scores on tests in Spanish measuring dementia averaged about 15 percent lower than African-Americans and about 30 percent lower than non-Hispanic whites. Latinos were on average about three-and-a-half years younger than non-Hispanic whites and about five years younger than African-Americans, he said.

Dr. Christopher M. Clark, director of the Center of Excellence for Research on Neurodegenerative Diseases at the University of Pennsylvania, studied the age at which 174 Alzheimer’s patients in California, New York and Pennsylvania first showed symptoms and found Spanish speakers were on average 6.8 years younger (about 67) than non-Hispanic whites, regardless of whether they were Mexican, Caribbean or South American. That Latinos are on average younger than other Americans accounted for a small part of the gap, but not most of it, Dr. Clark said.

Research is scant on the age of onset in Latinos remaining in their native homes, but Dr. Clark said patients in two clinics in Mexico and Puerto Rico did not show symptoms early.

Mary N. Haan, a University of Michigan epidemiologist heading the Sacramento Area Latino Study on Aging, studied 1,800 Mexican-Americans over 10 years and found greater likelihood of Alzheimer’s for those more “acculturated” to American society, based on a number of factors, including diet and social networks. Dr. Haan attributed that to higher stress from being “relatively poorer off” and “more socially isolated.”

Dr. Cruz, of the National Hispanic Council on Aging, said, “As you acculturate, you lose those protective factors linked to nutrition, physical activity, social support system, that come with you when you first arrive here.”

Dr. Haan found more acculturated people more prone to diabetes, and people with diabetes or obesity more likely to have Alzheimer’s. Researchers theorize that high insulin levels and poor cerebral blood flow can cause brain changes that accompany Alzheimer’s, said Dr. Jose A. Luchsinger, associate professor of medicine and epidemiology at Columbia University Medical Center.

Dr. Cruz said many Alzheimer’s risk factors “have to do with poor education,” which aggravates nutrition, financial status and health care.

Mrs. Mojica, from Puerto Rico, with five years of schooling, developed diabetes and hypertension after a hard life in a rundown row house, where she and her husband care for their 39-year-old mentally retarded son.

Not all Hispanics have medical or sociological risk factors.

Ida Lawrence, whose Alzheimer’s has made her hide money in socks and shower obsessively, attended high school in Honduras, learning English. Her husband, Robert, said he thought her dementia might be inherited, adding, “She’s been healthy except for the fact that she was coming down with this Alzheimer’s thing.”

Mr. Lawrence, who has prostate cancer, struggles to care for his wife, still only 63. “Everybody says to me, ‘Bob it’s going to get worse,’ ” he said.

Ms. Franklin finally moved her mother, Ms. Lopez, to a nursing home, where she cries and “doesn’t want nobody to touch her,” she said.

“It hurts me so much to see her like that,” Ms. Franklin said. “It’s like I can see her on one side of the mountain and say, that’s not my mom.”

Study: 25% of us have left childhood religions

More than a quarter of American adults have left the faith in which they were raised, switching to another religion or no religion at all, according to a national survey of religious affiliation.

In addition, adults who claim no ties to any religious institution have grown into the fourth largest category of religious affiliation, a trend led by California and states in the West, according to a report by the Pew Forum on Religion and Public Life.

Researchers said the large number of immigrants who have come to California from Central America and Asia have had an effect on the question of religious affiliation in the state as well as the makeup of particular denominations, particularly Catholics. While 10 percent of U.S. adults have left the Catholic Church, an influx of Catholic immigrants has kept the church's population stable.

Because the numbers of the unaffiliated have grown, Protestants are on the verge of becoming a minority in the United States. Only 51 percent of American adults describe themselves as Protestant.

In addition to the 28 percent of Americans who have left their childhood faith entirely, 16 percent have switched from the Christian denomination of their childhood to another Christian denomination.

The fluidity of affiliation in the United States underscores the competitiveness of the religious market, in which groups are vying for members, said Luis Lugo, director of the Pew Forum. "If you're going to rest on your laurels, you're history."

The survey of more than 35,000 adults was distinctive in the number of respondents as well as the number of questions posed. It found that 78 percent of the 220 million adults in the United States are still Christian.

Among Protestants, evangelicals are the largest single group, representing 26.3 percent of the nation's adult population. Mainline Protestant denominations - including Methodists, Presbyterians and Episcopalians - continue to see their numbers shrink, currently representing just 18.1 percent of the overall population. Historically black churches, which are increasingly taking on members of other ethnicities, represent 6.9 percent of the overall population.

Catholics are the second largest group of Christians, representing roughly 24 percent of the population - a relatively constant figure for the past 35 years.

But the constancy of that figure obscures the dramatic and unique way in which immigration patterns are reshaping America's religious identity, the survey found. Unlike in Europe, the majority of immigrants to the United States are Christian. And those immigrants are heavily Catholic, particularly those from Mexico.

Among immigrant adults, Catholics amount to 46 percent, while 24 percent are Protestants. But among U.S.-born adults, Protestants outnumber Catholics 55 to 21 percent.

The departures from the church mean that "roughly 10 percent of all Americans are former Catholics," the study found. While 31 percent of American adults were raised Catholic, only about 24 percent describe themselves as Catholic today.

These shifts are seen throughout the Bay Area, said George Wesolek, director of the Office of Public Police and Social Concerns within the Archdiocese of San Francisco.

St. Peter Church in the Mission District draws about 25,000 people every weekend, Wesolek said. The Catholic churches in East Palo Alto, the Bay Area's most heavily Latino city, hold most of their services in Spanish, he said.

The responsibilities of the parishes, the social mission of the church and the needs of the congregants are changing as a result.

"The Latino and immigrant base of the church is now making up the core, especially in California," said Wesolek, noting that Filipinos are a large portion of the archdiocese. "That has implications in almost every way." Priests must be multilingual, for example, and be able to meet the needs of different cultures.

The Western states have long been a destination for immigrants as well as the native-born, said John Green, a senior fellow at the Pew Forum and a principal author of the study. That mobility and lack of deep roots also play a role in the region's higher rate of the religiously unaffiliated, Green said, referencing other studies.

"The West was settled relatively late," he said. "It didn't have the tradition of established religious institutions that you have in the East or the South. They didn't have that history to draw upon."

That is compounded by immigration, particularly from Asia, which has brought other religious traditions, and that makes Western states like California distinct, he said.

"The West has always been quite diverse in religious terms and is especially diverse these days," he said. "And that level of diversity has created a group of people who aren't as interested in organized religion. They have other options."

Roughly 16.1 percent of the U.S. population describes themselves as not affiliated with any religious organization or body, a category that includes those who believe in God. In California, the unaffiliated account for 21 percent. Researchers said the numbers of atheists and agnostics - roughly 1.6 and 2.4 percent of the U.S. adult population - have remained consistent over time.

Those who are raised unaffiliated change their beliefs, too: Roughly half of those who were raised without a religious tradition now claim one as adults, according to the survey.

Green said the impact of the unaffiliated has yet to be seen. But it needs to be watched.

"The large size of this unaffiliated group could have a profound affect on the character of American religion," he said.

Sarcasm reigns as Hillary Clinton attacks Barack Obama's campaign

Sen. Hillary Clinton schmoozes with media and answers questions during flight to Rhode Island Sunday for campaign speech.

PROVIDENCE, R.I. - Hillary Clinton's assault on Barack Obama shifted from outrage to heavy sarcasm Sunday, with the former First Lady mocking her rival as much as chewing him out for his tactics.

Framing Obama as both a deceiver and a dream weaver, Clinton said "none of the problems we face will be easily solved."

Then oozing derision, Clinton cracked, "Now, I could stand up here and say, 'Let's just get everybody together. Let's get unified. The sky will open. The light will come down. Celestial choirs will be singing, and everyone will know we should do the right thing and the world will be perfect.'"

Her remarks drew chuckles from a supportive audience gathered at Rhode Island College.

"Maybe I've just lived a little long, but I have no illusions about how hard this is going to be," she said. "You are not going to wave a magic wand and have the special interests disappear."

Clinton's mockery of Obama came a day after she railed, "Shame on you, Barack Obama," decrying what she termed deceptive mailings in Ohio about her stances on universal health care and the North American Free Trade Agreement.

Later, in Boston, Clinton signaled she would continue her more aggressive approach against Obama. "I just have this sense that finally my opponent is getting maybe a little bit of scrutiny," she said.

The New York senator has a narrow lead over Obama in the Buckeye State and is trying to regain ground after 11 consecutive primary defeats.

Campaigning in Cleveland, Obama pushed back on the NAFTA issue, using quotes from Clinton's book to demonstrate her past support for the pact. NAFTA has been blamed for an exodus of jobs in pivotal states like Ohio, where Democrats vote March 4.

"Ten years after NAFTA passed, Sen. Clinton said it was good for America. ... Well, I don't think NAFTA has been good for America - and I never have," Obama said during a campaign stop at a wallboard factory. "The fact is, she was saying great things about NAFTA until she started running for President."

Clinton has said on the campaign trail that the trade agreement - which was passed during her husband's administration - is problematic.

Obama said Sunday that while he has issues with NAFTA, an attempt to repeal it "would probably result in more job losses than job gains in the United States."

A Clinton spokesman retorted that Obama has spoken positively of NAFTA in the past: "Sen. Obama's insistence on repeating attacks that have been demonstrated to be false by independent entities proves once and for all that his speeches about the new politics are just words."