Summary: A UCL-led analysis finds ethnic disparities in dementia medication in the UK: Asian and Black people with dementia are less likely to receive recommended anti-dementia treatments and tend to be prescribed antipsychotic drugs for longer periods than White patients, raising concerns about unequal quality of care.
Source: UCL
New UCL-led study finds disparities in dementia prescribing across ethnic groups in the UK
A large UK study led by University College London (UCL) has identified significant differences in how medications are prescribed to people with dementia from different ethnic groups. The research, published in Clinical Epidemiology, examined prescribing patterns and duration of treatment, revealing that people from Asian and Black ethnic groups do not always receive the same standard of pharmacological care as White patients.
“Our new findings are concerning as they appear to reflect inequalities in the care people receive to treat symptoms associated with dementia,” said the study’s lead author, Professor Claudia Cooper.
The investigators analyzed primary care records from The Health Improvement Network (THIN) database collected between 2014 and 2016. The dataset included 53,718 people diagnosed with dementia and a comparison group of 1,648,889 people aged 50 and over without dementia. The large sample enabled comparisons of prescribing initiation and the length of time different medicines were prescribed across White, Black and Asian ethnic groups.
Key findings include:
- Asian people with dementia were 14% less likely than White patients to be prescribed anti-dementia drugs when these medications were potentially indicated (adjusted prevalence rate ratio 0.86). On average, Asian patients received anti-dementia medicines for around 15 fewer days per year than White patients.
- Antipsychotic drugs—typically used to manage behavioural and psychological symptoms of dementia rather than core cognitive decline—were prescribed for longer durations among Black and Asian patients who received them. Black people with dementia who were prescribed antipsychotics had these medicines for about 27 days longer per year than White patients, and Asian patients for about 17 days longer per year. These extended durations exceed recommended limits and may increase the risk of harmful side effects.
- Black people with dementia were less likely to be prescribed anxiolytics or hypnotics (adjusted prevalence ratio 0.60), although the overall duration of these prescriptions was similar across groups. In unadjusted analyses, Asian people were more likely to be prescribed anticholinergic drugs (adjusted prevalence ratio 1.43), a class associated with potential cognitive harms; this finding was observed before adjusting for cardiovascular comorbidities.
Anti-dementia medications—cholinesterase inhibitors and memantine—are the primary drug options aimed at helping memory and other cognitive abilities in dementia. Antipsychotics and other psychotropic drugs are generally recommended only when non-pharmacological options have failed and symptoms are severe, because antipsychotics can increase risks such as falls, further cognitive decline, stroke and even death.
The study did not find substantial differences in the rate of initial antipsychotic prescriptions across ethnic groups, suggesting that the disparities may lie in how frequently medications are reviewed and discontinued. In other words, once prescribed, antipsychotics appear to be stopped less promptly for some minority groups.
Researchers suggest several possible contributors to these disparities: socioeconomic disadvantage limiting access to services, language and cultural barriers affecting communication with clinicians, and variable availability or use of non-pharmacological supports. They also note that while antipsychotic prescribing in the UK has declined sharply over the past decade, current patterns indicate more work is needed to ensure safe, guideline-based prescribing for all people with dementia.
Professor Jill Manthorpe, co-author and member of the NIHR Health & Social Care Workforce Research Unit at King’s College London, urged clinicians to consider whether antipsychotic medications are being used instead of other available forms of support. “Families and clinicians should ask about alternatives such as social prescribing and culturally appropriate activities that can reduce distress—examples might include music, meaningful sensory stimulation, or tactile experiences,” she said.
Dr Mary Elizabeth Jones, first author from the UCL Institute of Epidemiology & Health Care, added that even a few additional weeks on antipsychotic medication may have clinically meaningful consequences and warrants attention. She recommended further work to ensure dementia care services consistently meet prescribing guidelines and are culturally competent.
The lead researchers note that previous international studies from the USA and Australia have reported similar treatment inequalities for minority ethnic groups, but this is the first large-scale study to document these patterns in the UK in detail. Earlier work by Professor Cooper also indicates higher dementia rates in Black populations and potential delays in diagnosis for some ethnic minority groups. Separate research has highlighted gender differences in dementia care, where women may receive fewer GP visits and more potentially harmful medications than men.
Funding: This research was supported by The Dunhill Medical Trust.
Source: UCL
Original research: “Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom.” Jones ME, Petersen I, Walters K, Bhanu C, Manthorpe J, Raine R, Mukadam N, Cooper C. Clinical Epidemiology. DOI available in the original publication.
Conclusion: The study highlights important ethnic disparities in dementia pharmacotherapy in the UK—Asian groups received fewer potentially beneficial symptomatic treatments, while Asian and Black groups who received antipsychotics experienced longer durations of use compared with White groups. These findings point to possible inequalities in care and underscore the need for consistent guideline-based prescribing and culturally competent dementia services.