Objective: To investigate recognition of parkinsonism in African Americans (AA) in a community-based sample in Chicago.

Background: Prior studies suggest that the manifestation of parkinsonism may be fundamentally different in AA compared to white patients as evidenced by greater disability and severity. A lower likelihood of receiving care, barriers to specialized neurological care, and methodological confounds have been proposed to explain the disparity.

Methods: Subject data was compiled from three ongoing community-based epidemiological studies at Rush University. Participants underwent a structured, uniform evaluation including a medical history, a modified motor section of the Unified Parkinson’s disease Rating Scale (UPDRS), and neuropsychological testing. Medications were inspected for dopaminergic prescriptions, and demographic and psychosocial variables, including perceived everyday discrimination, were collected. Parkinsonism was determined by the study team based on the presence of two of four signs (bradykinesia, tremor, rigidity, gait instability) defined by two or more items present in each domain.

Results: 1069 AA (78% women) subjects were included, with 23% (n=250) meeting criteria for parkinsonism. AA with parkinsonism were significantly older (79.8±7.8 vs. 75.2±6.2 yrs, p<0.001), less educated (13.5±4 vs 14±4 yrs, p<0.001), had lower income at age 40 ($30,588 vs. $41,195, p<0.001), higher discrimination scores (p=0.007), and lower cognition (p<0.001). Of the AA with parkinsonism, 87% had two domains present, 13% had three domains, and no subjects had four domains. 61% of subjects with parkinsonism did not report previous medical diagnosis or treatment for PD or parkinsonism.

Conclusions: Nearly a quarter of a community-based sample of AA were found to have parkinsonism and the majority of them were not diagnosed or treated for parkinsonism or PD. This study suggests poor recognition of parkinsonism in AA in the community, which may be a cause of reduced referral for neurological care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/recognition-of-parkinsonism-in-african-americans-in-a-community-based-sample/