Dr. Sharon A. Brangman, MD, FACP, AGSF, is a SUNY Distinguished Service Professor and Chair of the Department of Geriatrics at SUNY Upstate Medical University in Syracuse, New York. As Director of the Center of Excellence for Alzheimer’s Disease and a nationally recognized geriatrician, Dr. Brangman has dedicated her career to improving the health and wellness of older adults, especially within underserved and marginalized communities. With specialties in Internal Medicine, Geriatrics, and Hospice and Palliative Medicine, she leads transformative research and education initiatives, particularly around Alzheimer’s disease and equitable healthcare access.
In this exclusive interview with Revelence Media, Dr. Brangman sheds light on the disproportionate impact of Alzheimer’s disease on Black Americans and the urgent need for lifelong brain health awareness and advocacy.
Revelence: Alzheimer’s disease disproportionately affects Black Americans, yet they are often underdiagnosed and undertreated. What are some of the key factors contributing to these disparities?
Dr. Sharon Brangman: There are several factors. First, many people don’t know the difference between normal aging and memory loss caused by disease. I often see patients with advanced Alzheimer’s because early signs were ignored or misunderstood as normal aging.
Another major issue is access to care. Some individuals don’t have a primary care doctor or see doctors who dismiss their concerns. I’ve had patients tell me their doctor said, “What do you expect at your age?”—implying memory loss is normal, which delays treatment.
We also need to think more broadly. Alzheimer’s is a disease of aging, but brain health is something we must care for across our entire lifespan—not just after age 60. That’s a message I’m really trying to get out.
How do socioeconomic and healthcare access issues impact the likelihood of Black Americans receiving an early and accurate diagnosis?
Access is key. You need health insurance, a primary care provider, and ideally a specialist. Depending on where you live, it might be difficult to access a memory clinic or geriatrician.
Work schedules also matter. Many people don’t have paid sick leave or flexible jobs, so they skip medical appointments. On top of that, a healthy diet can be expensive. Processed foods, which are often more affordable, aren’t good for the brain.
It’s not genetic predisposition driving disparities in Alzheimer’s—it’s social determinants of health. Chronic stress from racism, economic instability, and lack of support adds to that risk. Stress raises blood pressure, increases blood sugar levels, and contributes to diabetes and obesity—all of which are risk factors for Alzheimer’s.
You mentioned stress. Often, we don’t even realize how stressed we are. How can someone identify signs of stress in their life?
That’s very true—stress becomes so normalized we don’t even notice it. That’s why having a healthcare provider you trust is important. They can check your blood pressure, ask about your sleep, and talk through your day-to-day concerns.
Trouble falling or staying asleep, racing thoughts, changes in appetite—these are all signs of stress. It’s also important to talk to someone: a trusted friend, a family member, someone in your faith community, or a therapist. Unfortunately, therapy isn’t always accessible due to cost or stigma, so we often try to manage alone, which doesn’t always work well.
Over time, chronic stress can wear your body down. And new research shows that even environmental factors—like air pollution—can increase Alzheimer’s risk. We know that many Black communities are located in areas with more pollution and fewer trees, which compounds the problem.
That’s both enlightening and troubling. So, what’s your message to the community regarding Alzheimer’s prevention and brain health?
Brain health is lifelong. Start early—eat well, exercise, manage stress, sleep properly, and stay socially connected. Get regular checkups and be persistent in advocating for yourself or your loved ones if you notice memory changes.
Also, participate in research and learn more about the disease. We need more representation in clinical studies so treatments are effective for everyone. There’s still a lot of work to do, but the more we talk about brain health openly, the better equipped we’ll be to protect our minds and our communities.
Historically, Black Americans have been underrepresented in clinical research, which leads to treatments that may not fully address our needs. Why is it crucial for Black patients to participate in Alzheimer’s research, including the Benfo Team Study?
Dr. Sharon Brangman: I’m part of the Benfo Team Study, and unfortunately, many current treatments for Alzheimer’s disease have included very few Black, Asian, or Latino participants. That’s a problem because we don’t fully understand how these drugs may affect us. It’s critical to be involved in research so we can get treatments that work for everyone.
One of the main reasons people don’t participate is simply because they haven’t been asked. Doctors and other healthcare providers often overlook inviting people of color to be part of these studies. Additionally, trust is essential. There’s a historical legacy of unethical research practices, and while that’s not always top of mind, many people base their decisions on whether they trust the healthcare system today.
If someone feels they’re being discriminated against in their day-to-day care, they’re less likely to engage in research. Building trust and relationships with communities takes time and effort—something many large research centers have not consistently done. You can’t just reach out when you need participants; you have to show up, listen, and support the community year-round.
That’s what we’ve been doing—outreach, education on memory loss, what’s normal, what’s not, and why it’s so important to be part of the solution. We already know the risk is higher in our communities. I’m ready to move past just talking about risk and start focusing on solutions—and participating in research is a powerful way to do that, for ourselves, our children, and our grandchildren.
You briefly touched on the historical mistrust many in the Black community have toward healthcare providers and medical research. How can researchers and professionals rebuild that trust?
That’s a very important question—and it requires a lot of work. First, researchers must understand the historical reasons for that mistrust. Beyond conducting their studies, they need to invest time and effort into building genuine relationships within diverse communities. Some are beginning to recognize the importance of this work.
You also mentioned that many of us simply don’t participate in clinical trials. Outside of a doctor’s referral, how can people find opportunities to be part of these studies?
Sometimes clinical trials are advertised through radio, TV, or community organizations, but many people overlook those messages. Most often, referrals come from your doctor. We are also working on outreach through community groups to help spread information. It’s also important to note that research today is highly regulated. Studies undergo rigorous review processes, so the unethical practices of the past are no longer tolerated, which helps to reassure potential participants.
You mentioned that early detection is key, especially with memory issues. But what about people who dismiss their symptoms—how do we address that?
That’s very common. People often explain away symptoms by saying they’re retired and don’t need to remember the day or time, or that they’re just tired. But any concerns about memory should be brought up with a doctor. And if a doctor dismisses it by saying, “What do you expect at your age?”—that’s a red flag. You should find another provider.
Let’s talk about the trial you mentioned earlier with the Benfo Team. What does participation actually involve?
This trial is based on the theory that low levels of vitamin B1, also called thiamine, in the brain may lead to memory issues. Interestingly, you can have normal levels in your blood but still be deficient in your brain. As we age, our brains may need higher doses. This trial involves taking a specially formulated pill to increase thiamine levels in the brain—no shots or IVs required.
When considering participation, people should ask: What do I have to do? How much time is involved? Are there any costs? Most reputable studies cover transportation and other expenses. But one key issue is that researchers often don’t understand participants’ daily lives. Expecting someone to spend 4–5 hours at a research center isn’t realistic. That’s why it’s critical to involve communities in the planning stages of research, so the process is accessible and inclusive.
Just to clarify—Are vitamin B1 and thiamine are the same thing?
Yes, exactly. Vitamin B1 is also called thiamine. In medicine, many things have two names, which can be confusing. B vitamins overall are essential for brain and nerve health, but this study focuses specifically on vitamin B1 because of its potential role in memory and cognitive function.
Should people start taking B vitamins at a certain age, or should that be determined by a doctor?
Generally, if you’re eating a healthy diet, you should be getting all the necessary vitamins. However, this situation is a bit different. Even with normal levels of vitamin B1 in the bloodstream, you might still have low levels in the brain, which could increase your risk for Alzheimer’s disease. This trial looks at whether a specially designed version of the vitamin can improve brain health and possibly slow down or prevent memory-related conditions.
For more information on the Benfo Team Study, visit https://www.benfoteam.org/
References
BenfoTeam clinical trial. – https://www.benfoteam.org/
Brangman, S. A. (n.d.). SUNY Upstate Medical University. Retrieved from https://www.upstate.edu
Alzheimer’s Association. (2023). Race, ethnicity and Alzheimer’s in America. Retrieved from https://www.alz.org
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