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Potential ethnic modifiers in the assessment and treatment of Alzheimer's disease: challenges for the future

Published online by Cambridge University Press:  23 April 2007

Warachal E. Faison
Alzheimer's Research and Clinical Programs, Neurosciences Department, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Susan K. Schultz
University of Iowa College of Medicine, Iowa City, Iowa, U.S.A.
Jeroen Aerssens
Department of Internal Medicine, Johnson & Johnson Pharmaceutical Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
Jennifer Alvidrez
Department of Psychiatry, University of California, San Francisco, California, U.S.A.
Ravi Anand
Anand Pharma Consulting, Oberwil, Switzerland
Lindsay A. Farrer
Genetics Program, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, U.S.A.
Lissy Jarvik
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, and Department of Veterans Affairs, VA Greater Los Angeles Health Care System, Los Angeles, California, U.S.A.
Jennifer Manly
Columbia University Medical Center, New York, U.S.A.
Thomas McRae
Alzheimer's Disease Management Team, Pfizer Inc. and New York University School of Medicine, New York, U.S.A.
Greer M. Murphy
Neuroscience Research Laboratories, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, U.S.A.
Jason T. Olin
Medical Affairs, Forest Research Institute, Jersey City, New Jersey, U.S.A.
Darrel Regier
Division of Research, American Psychiatric Association and American Psychiatric Institute for Research and Education (APIRE), Arlington, Virginia, U.S.A.
Mary Sano
Alzheimer Disease Research Center, Mount Sinai School of Medicine and James J. Peters VA Medical Center, Bronx, New York, U.S.A.
Jacobo E. Mintzer
Division of Translational Research, Neurosciences Department, Medical University of South Carolina, Charleston, South Carolina, and Ralph H. Johnson VA Medical Center Charleston, South Carolina, U.S.A.


Objective: Despite numerous clinical trials, it is unknown whether ethnicity affects treatment response to cognitive enhancers in Alzheimer's disease (AD). There is convincing evidence of ethnic and genetic variability in drug metabolism. This article reviews the available data on ethnicity in clinical trials for AD to answer two questions: (1) what are the challenges to diagnose and treat AD across different ethnic groups, and (2) are there differences in response to pharmacologic interventions for AD across these different ethnic groups?

Method: Available data from Alzheimer's Disease Cooperative Study (ADCS) randomized controlled clinical trials and from randomized controlled industry-sponsored trials for four cognitive enhancers (donepezil, galantamine, rivastigmine and sabeluzole) were pooled to assess the numbers of non-Caucasian participants.

Results: The participation of ethnic minority subjects in clinical trials for AD was dependent on the funding source, although Caucasian participants were over-represented and non-Caucasian participants were under-represented in the clinical trials. Because of the low participation rate of ethnic minorities, there were insufficient data to assess any differences in treatment outcome among different ethnic groups. Strategies to improve diversity in clinical trials are discussed.

Conclusion: Greater participation of ethnically diverse participants in clinical trials for AD would generate additional information on possible differences in metabolism, treatment response, adverse events to therapeutic agents, and could foster the investigation of genetic variability among ethnic groups.

Review Article
International Psychogeriatric Association 2007

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