During the “long goodbye” of Alzheimer’s disease, cherished memories slip away—years of spirited conversations, family recipes and collected wisdom—and with them, the ability to make new memories. The losses are incalculable and multiply across generations and communities.

Hispanic Americans are 1.5 times more susceptible to dementia than non-Hispanic white Americans, but few are represented in current research, including in the studies that led to recent anti-amyloid drug approvals. Latin people comprised just 3% of clinical trial participants for aducanumab and 12.4% for lecanemab, even though the group makes up 19% of the U.S. population.

“If we continue to only study homogenous groups of people—and don’t know how the disease manifests in Latin people, for example—that limits how much we can understand about the full diversity of mechanisms across the population and risks us not connecting people to therapies as they become available,” said Mitzi Gonzales, PhD, director of Translational Research at the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai.

Gonzales is a champion for the study of dementia in Latin communities and other groups that historically have been underrepresented in medical research and care. In a federally funded trial based in Texas, she evaluated the brain effects of physical, cognitive and social activity on older Mexican American adults. In an upcoming study, Gonzales will use neuroimaging and genetics to explore Alzheimer’s disease risks among Latin people, who are projected to see the sharpest surge in Alzheimer’s disease cases—up to fourfold—of any ethnic group by 2060.

Read: Cedars-Sinai Experts Discuss the Mysteries of Memory

Mitzi Gonzales: Among Latin communities in the U.S., we are trying to understand the interaction between brain tau deposition and cerebrovascular damage, because most people who have dementia or Alzheimer’s disease also have cerebrovascular pathology. Individuals from historically marginalized groups, including Latin, Black and Asian people in the U.S., are less likely to have detectable disease based on amyloid imaging, suggesting that other factors, such as vascular damage, may contribute to the clinical presentation.

Neuroimaging provides rich data on the spatial distribution of tau protein accumulation, which we use to identify patterns most predictive of future risk of Alzheimer’s disease or other neurodegenerative diseases. We also want to understand how the patterns of tau buildup in the brain potentially relate to associations with blood-based biomarkers for Alzheimer’s disease, as these tools are becoming more and more frontline in dementia screening.

The other question at the crux of our research is how these biological changes intersect with social drivers of health.

MG: Recent meta-analyses suggest the APOE4 gene, which is the largest genetic risk factor for sporadic Alzheimer’s disease, is less strongly associated with risk in the Latin community than other racial and ethnic groups. Indigenous ancestry might be somewhat protective. The discrepancy of higher rates of Alzheimer’s in a population that has perhaps more resilience to the disease from a genetic perspective speaks to the role of health disparities.

Diabetes and uncontrolled hypertension—major modifiable risk factors for Alzheimer’s disease—are more prevalent among Latin people in the U.S. and fueled by disparities in access to high-quality care (including the highest uninsured rate among racial and ethnic groups); safe, local exercise (especially neighborhood walkability); and community food availability and affordability. Hispanic Americans have 2.2 times the risk of food insecurity compared with their non-Hispanic white counterparts. We’re also just starting to understand the role of stress and serious adverse life events, including discrimination.

Beyond trying to understand these associations, we need to understand mechanisms. For instance, researchers are interested in neighborhood environmental factors, particularly how pollutants might lead to epigenetic changes that could affect risk or resilience to disease.

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MG: The impetus is on researchers to make participation meaningful and accessible to diverse communities, including Latin, Asian and Black Americans as well as LGBTQIA+ people, all of whom are more vulnerable to dementia. The Jona Goldrich Center for Alzheimer’s and Memory Disorders has formed a Community Advisory Board to guide us in tailoring study protocols to areas of concern and is engaged in community outreach and education. One focus is prevention, such as treating vascular risks.

Unfortunately, people often don’t seek care until they are symptomatic, and Latin communities and other groups that have historically lacked access to high-quality care experience much longer diagnostic delays on average. Characterizing preclinical dementia brain signals among racial and ethnic minorities could enable earlier detection and treatment. We’re now in an era where we’ve recently had new Alzheimer’s disease medications approved that slow disease progression, and hopefully more will proliferate. It is important that we treat people as early as possible to offer the most benefit.

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MG: Genetic factors such as the APOE4 allele might inform us about pathways and mechanisms that we could eventually target to protect people. When we understand the interplay between environmental and medical risk exposures and how this translates into risk and resilience, we can ensure treatments are effective, available and accessible to everyone who needs them and lessen the global burden of this devastating disease.