To investigate disparities along racial/ethnic lines regarding medications used in the outpatient management of dementia.

The benefits of medications used in the treatment of dementia are not equally distributed in society, and there is evidence for disparities in their utilization in nursing homes and hospitals. However, there remains limited data on these disparities in the outpatient setting.

In this retrospective study, information on demographics (including self-reported race/ethnicity), outpatient medications, and referrals to specialists was collected on all patients with a diagnosis of dementia seen at Mount Sinai, a multicenter academic healthcare institution. Frequencies for the utilization of five medication classes (cholinesterase inhibitors, NMDA-antagonists, SSRIs, antipsychotics, and benzodiazepines) were compared among patients with different race/ethnicity using Chi-square and logistic regression, controlling for age, sex, primary language, marital status, and insurance type.

Black patients living with dementia were receiving cognitive enhancers less frequently in comparison to White patients (20.4% vs. 30% for cholinesterase inhibitors, 9.9% vs. 16.7% for NMDA-antagonists). Additionally, Black patients living with dementia less frequently received medications for behavioral and psychological management in comparison to White patients (23.9% vs. 39.9% for SSRIs, 18% vs. 21.7% for antipsychotics, and 17.5% vs. 36.8% for benzodiazepines; p<0.001). A logistic regression controlling for confounders showed that Black patients received all medications significantly less frequently than White patients, despite receiving more referrals to specialists than white patients. Black patients who received neurology consults received cholinesterase inhibitors and NMDA antagonists comparably to White patients.

Racial disparities exist in the utilization patterns of all dementia-related medications, with Black patients receiving them less frequently than White patients in the outpatient setting. Referrals to specialists such as neurologists may decrease these disparities. More research is needed to understand the root cause of such disparities and design programs to eliminate them.