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Abstract：
Disparities in diagnosis persist among persons living with dementia (PLWD); most research on delayed diagnosis relies on medical records or administrative claims. This study aimed to identify factors that delay or facilitate dementia diagnoses in racial or ethnic minoritized PLWD and elicit care partner perspectives on timing and effects of diagnosis.
Maryland-based participants cared for a PLWD age 60 or older, self-identified as Black/African/African-American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in-depth, semi-structured interviews were conducted and analyzed using conventional qualitative content analysis methods.
Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding dementia influenced recognition and discussion of dementia among families and communities. Diagnoses were family-initiated and started in primary care. Care partners were divided in their perceptions of diagnosis timeliness and whether earlier diagnosis would have changed outcomes. Family reactions to dementia diagnoses varied; most participants expressed a strong sentiment of service and duty to care for older family members. Participants overwhelmingly felt the benefits of obtaining a dementia diagnosis outweighed harms.
Numerous factors affect dementia diagnosis in racial and ethnic minoritized PLWD. Normalization of brain health discussions and systematic, proactive discussion and detection of dementia in primary care may address multilevel barriers and facilitators to diagnosis. Systems-level and community-led public health interventions may also help address disparities in brain health education and dementia diagnosis.
Maryland-based participants cared for a PLWD age 60 or older, self-identified as Black/African/African-American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in-depth, semi-structured interviews were conducted and analyzed using conventional qualitative content analysis methods.
Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding dementia influenced recognition and discussion of dementia among families and communities. Diagnoses were family-initiated and started in primary care. Care partners were divided in their perceptions of diagnosis timeliness and whether earlier diagnosis would have changed outcomes. Family reactions to dementia diagnoses varied; most participants expressed a strong sentiment of service and duty to care for older family members. Participants overwhelmingly felt the benefits of obtaining a dementia diagnosis outweighed harms.
Numerous factors affect dementia diagnosis in racial and ethnic minoritized PLWD. Normalization of brain health discussions and systematic, proactive discussion and detection of dementia in primary care may address multilevel barriers and facilitators to diagnosis. Systems-level and community-led public health interventions may also help address disparities in brain health education and dementia diagnosis.
摘要：
背景：痴呆症患者（PLWD）的诊断差异仍然存在；大多数关于延迟诊断的研究依赖于医疗记录或行政索赔。这项研究旨在确定在种族或种族化的PLWD中延迟或促进痴呆症诊断的因素，并激发护理伙伴对诊断时机和效果的看法。
方法：马里兰州的参与者照顾60岁或以上的PLWD，自称为黑人/非洲/非洲裔美国人，亚洲人,或者西班牙裔/拉丁裔，说英语.深入了解十九位护理伙伴，半结构化访谈进行了分析，使用常规的定性内容分析方法。
结果：生物学，社会文化,和环境因素延迟痴呆诊断。记忆丧失是最常见的早期症状,但是发病通常是微妙的或被认为是正常的衰老。围绕痴呆症的污名和保密影响了家庭和社区对痴呆症的认识和讨论。诊断是由家庭发起的，并在初级保健中开始。护理伙伴对诊断及时性以及早期诊断是否会改变结果的看法存在分歧。家庭对痴呆症诊断的反应各不相同；大多数参与者表达了强烈的服务和照顾年长家庭成员的责任。参与者压倒性地认为获得痴呆症诊断的好处大于危害。
结论：许多因素会影响种族和少数民族化PLWD的痴呆诊断。标准化大脑健康讨论和系统，在初级保健中积极讨论和发现痴呆可以解决多层次的障碍和促进诊断.系统层面和社区主导的公共卫生干预措施也可能有助于解决大脑健康教育和痴呆症诊断方面的差异。
方法：马里兰州的参与者照顾60岁或以上的PLWD，自称为黑人/非洲/非洲裔美国人，亚洲人,或者西班牙裔/拉丁裔，说英语.深入了解十九位护理伙伴，半结构化访谈进行了分析，使用常规的定性内容分析方法。
结果：生物学，社会文化,和环境因素延迟痴呆诊断。记忆丧失是最常见的早期症状,但是发病通常是微妙的或被认为是正常的衰老。围绕痴呆症的污名和保密影响了家庭和社区对痴呆症的认识和讨论。诊断是由家庭发起的，并在初级保健中开始。护理伙伴对诊断及时性以及早期诊断是否会改变结果的看法存在分歧。家庭对痴呆症诊断的反应各不相同；大多数参与者表达了强烈的服务和照顾年长家庭成员的责任。参与者压倒性地认为获得痴呆症诊断的好处大于危害。
结论：许多因素会影响种族和少数民族化PLWD的痴呆诊断。标准化大脑健康讨论和系统，在初级保健中积极讨论和发现痴呆可以解决多层次的障碍和促进诊断.系统层面和社区主导的公共卫生干预措施也可能有助于解决大脑健康教育和痴呆症诊断方面的差异。
