Understanding Racial and Ethnic Differences in Antidementia Medication Initiation

Research shows that Hispanic and Black Medicare beneficiaries with Alzheimer's or related dementias start antidementia medications at different rates than white beneficiaries, and they also stop them sooner. This can feel confusing or unfair, but knowing these patterns helps you ask the right questions and advocate for your loved one. There are concrete steps you can take to ensure fair access to treatment and to support medication adherence, no matter your background.

Key points

• Hispanic beneficiaries are more likely to start antidementia medication than white beneficiaries, but both Hispanic and Black beneficiaries stop it sooner.
• Early discontinuation (within 1 month) happens in 23% of all starters, and 62% stop within a year—so monitoring and follow-up are critical.
• Cost, side effects, and lack of follow-up care may contribute to faster discontinuation in minority groups.
• Ask your doctor about all medication options, including generics, and schedule a follow-up within 1-3 months.
• Use a simple log to track side effects and cognitive changes, and bring it to every appointment.
• Cultural and language barriers can affect care—ask for an interpreter or a second opinion if needed.

What the Research Shows About Initiation and Discontinuation

A large study of Medicare fee-for-service beneficiaries found that overall, only about 4% of people who had not previously used antidementia medications started them in a six-month period. Among those who did start, Hispanic beneficiaries were about 25% more likely to initiate treatment compared to white beneficiaries. Black and white beneficiaries did not differ in their likelihood of starting medication. However, once started, both Hispanic and Black beneficiaries were more likely to discontinue the medication sooner than white beneficiaries—Hispanic beneficiaries were about 56% more likely to stop, and Black beneficiaries about 25% more likely. This means that even when treatment begins, it may not be sustained equally across groups.

Why These Differences Matter for Your Loved One

Antidementia medications like donepezil, rivastigmine, galantamine (acetylcholinesterase inhibitors) and memantine are intended to help manage symptoms and slow progression in early to moderate stages. Discontinuing them early—especially within the first month—means missing out on potential benefits. The study found that 23% of all initiators stopped within one month, and 62% stopped within one year. For Hispanic and Black families, faster discontinuation may be linked to side effects, cost, access to follow-up care, or cultural beliefs about medication. Understanding this pattern helps you be proactive: ask about side effect management, check if cost is a barrier, and schedule regular follow-ups to monitor how the medication is working.

The Bigger Picture: Disparities in Diagnosis and Care

Hispanic and Black older adults are about twice as likely to develop Alzheimer's disease compared to white individuals, yet they are less likely to receive specialized care and more likely to experience delayed or missed diagnosis. This means that by the time medication is considered, the disease may already be more advanced. Additionally, underrepresented groups are often left out of clinical trials, so the evidence base for these medications may not fully reflect how they work in diverse populations. As a caregiver, you can help bridge this gap by insisting on a thorough evaluation, asking about all treatment options, and sharing your family's health history with the clinician.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Does taking other cognition-impairing drugs affect how long my family member stays on their dementia medication?

Yes, other cognition-impairing drugs can affect adherence by adding side effects that make your loved one want to stop – track any new confusion or drowsiness in a simple log and share it with the doctor within the first month.

Discuss with your clinician

Ask your doctor: 'Given my loved one's race/ethnicity, are there any specific considerations for starting or continuing antidementia medication?'

Discuss: 'What is the exact cost of this medication under our Medicare Part D plan? Are there generic or assistance options?'

Ask: 'How long should we try this medication before deciding if it's working? What signs of improvement or decline should I watch for?'

If side effects occur, ask: 'Can we lower the dose or switch to a different medication in the same class?'

If the medication is stopped, ask: 'What non-drug strategies can we use to support memory and function now?'

Related guides

• Building a medication routine for a person with dementia
• Sleep medication safety in dementia
• Side effects and monitoring of Alzheimer's medications (donepezil, galantamine, rivastigmine, memantine)
• cross-cultural learning from elders with dementia
• ADA legal protections for dementia patients
• FDA-Approved Medications for Alzheimer's Disease: A Practical Guide for Caregivers and Early-Stage Patients
• Caregiver advocacy in Australia

Sources

• NICE
• PubMed
• PMC
• Alzheimer's Association
• Mayo Clinic
• aaic.alz.org
• UCLA Health
• Better Health While Aging
• Dementia Doc