When Stress Becomes Structure

How Alzheimer’s Looks in Black Women on a Neuropsychological Level, and What We Can Do About It in the Pre-Mortem Phase

Alzheimer’s disease is not a single pathology; it is an intersection of genetics, stress biology, and lived environment. For Black women in the United States, each of these dimensions converges inside a healthcare system built on omission. Genetic risk factors such as ABCA7 variants and differences in amyloid and tau expression combine with lifelong environmental exposures, chronic stress, poor sleep, vascular burden, and systemic inequity to alter the neuropsychological trajectory of the disease. This article urgently examines the neurobiology, neuroimaging, and cognitive profiles of Alzheimer’s in Black women. It applies psychologist Gary Klein’s “pre-mortem” framework: identifying early neurological stress signatures before they become irreversible decline.

Genetic Factors: The Blueprint That Is not Destiny

Black women are more likely to carry the ABCA7 genetic variant, a risk allele associated with disrupted lipid metabolism and amyloid deposition (Stepler et al., 2022). Unlike the APOE-ε4 allele that dominates white Alzheimer’s studies, ABCA7 explains a disproportionate share of risk among African Americans.

Large-scale genomic analyses reveal that race-specific molecular pathways shape protein folding, inflammation, and neuronal repair differently (Seifar et al., 2024). However, most genome-wide association studies still underrepresent Black participants, limiting translational accuracy.