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A new Alzheimer's study suggests where you live can affect the odds of a diagnosis
Medical instruments are pictured at the Actors Fund’s Al Hirschfeld Free Health Clinic on March 23, 2011, in New York City. Researchers found that the odds of getting a formal dementia diagnosis in the U.S. differed based on location.
Spencer Platt/Getty Images
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Spencer Platt/Getty Images
In the United States, it’s estimated that about 7 million people are living with Alzheimer’s disease and related dementias. But the number of people with a formal diagnosis is far less than that. Now, a new study suggests the likelihood of getting a formal diagnosis may depend on where a person lives.
Researchers at the University of Michigan and Dartmouth College found that diagnosis rates vastly differ across the country and those different rates could not simply be explained by dementia risk factors, like if an area has more cases of hypertension, obesity and diabetes.
The reasons behind the disparity aren’t clear, but researchers speculate that stigma as well as access to primary care or behavioral neurological specialists may impact the odds of getting a formal diagnosis.
“We tell anecdotes about how hard it is to get a diagnosis and maybe it is harder in some places. It’s not just your imagination. It actually is different from place to place,” said Julie Bynum, the study’s lead author and a geriatrician at the University of Michigan Medical School.
Those differences may have potential consequences. That’s because a formal diagnosis of Alzheimer’s opens up access to treatments that may slow down the brain changes associated with the disease. Without that formal diagnosis, patients also would not be eligible for clinical trials or insurance coverage for certain medications. Even in cases of dementia where treatment is not an option, a diagnosis can also help in the planning for a patient’s care.
The findings, published last week in the journal Alzheimer’s & Dementia, emerged from two main questions: What percent of older adults are being diagnosed with dementia across communities in the U.S.? And is the percent we see different from what we would expect?
To answer these questions, researchers used Medicare and demographics data to create two maps. The first displayed the percentage of people receiving a formal diagnosis in each hospital referral region (HRR), which divides the country into 306 areas based on where people are likely to seek treatment. The second estimated what the percentage should be in each HRR based on health risk factors and race.
What they discovered was that the two maps were vastly different, with parts of the Great Plains and Southwest seeing less diagnosis than expected. For example, a person in Wichita Falls, Texas, may have twice the likelihood of getting a diagnosis than a person living in Minot, N.D.
“Even within a group of people who are all 80, depending on where you live, you might be twice as likely to actually get a diagnosis,” Bynum said.
It’s difficult to say for certain if an area is under-diagnosing, because researchers compared each HRR to the national diagnosis average instead of the actual number of cases in each community, she added.
But the findings shed new light on why dementia diagnosis is more prevalent in some areas than others — and that it does not simply have to do with an individual’s risk factors alone, but also access to health care resources and education on the disease.
Erin Abner, an epidemiologist at the University of Kentucky who was not involved in the study, said the results were not surprising and that there are many barriers to diagnosis.
“Where we live is a powerful influence on our brain health,” she said. “It is very difficult for adults in many parts of the country to access behavioral neurological specialist care — in many cases waiting lists to be seen are months or even years long.”
For some, language and cultural differences can also impact access to care.
Diagnosing Alzheimer’s can be a long process that includes cognitive and neuropsychological assessments, as well as tests showing the presence of amyloid plaques in the brain. Bynum hopes the findings will help draw attention to the role that health care systems have on diagnosis rates and finding people who may be living with dementia under the radar.
“This other component of what the health care system and our public health system might do in informing and educating populations, that’s also relevant and important,” Bynum said. “And in some ways, we can fix that.”
Rep. Nancy Pelosi, D-Calif., and her husband Paul arrive at the funeral services for Clive Davis at Central Synagogue in New York, Monday, June 29, 2026.
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Adam Gray/AP
LOS ANGELES — The husband of former House Speaker Nancy Pelosi was involved in a hit-and-run in California that left a parked car with “major” damage authorities said Saturday, and he could face misdemeanor charges.
Paul Pelosi was driving his brown convertible Friday in Yountville, a town in the heart of wine country, when he struck a legally parked car on the side of the road, briefly stopped and then drove away, the Napa County Sheriff’s Office said in a statement. No injuries were reported.
A witness saw the collision and called 911. Shortly afterward sheriff’s deputies found Pelosi with damage to the front of his car on a road roughly a quarter of a mile away. He reportedly told officers he knew he hit something but was not sure when or what caused the damage.
Pelosi, 86, did not have any alcohol in his system, according to the statement. The sheriff’s office referred him to the Department of Motor Vehicles for a process to determine whether he may continue to drive — something that officials say is common for older drivers.
Pelosi was not arrested, and because no one was injured, the sheriff’s office recommended a misdemeanor charge for fleeing the scene of an accident.
A staffer for Nancy Pelosi did not immediately respond to an email seeking comment.
Paul Pelosi pleaded guilty in 2022 to misdemeanor charges of driving under the influence in Napa County and was sentenced to five days in jail and three years of probation. However, he served only two days in jail and received good conduct credit for two other days, leaving just one day to serve in a work program at the courthouse.
As part of his probation, Pelosi was required to attend a three-month drinking driver class and install an ignition interlock device, which forces drivers to provide a breath sample to prove sobriety before the engine will start. He also was ordered to pay about $5,000 in victim restitution for medical bills and lost wages, along with nearly $2,000 in fines.
That same year he was attacked and severely beaten with a hammer at the couple’s San Francisco home.
WASHINGTON (7News) — The thousands of people attending the Great American State Fair and other areas around the National Mall are being ordered to evacuate as stormy weather approaches.
The National Weather Service previously announced a Severe Thunderstorm Warning in the District. Officials are asking attendees to seek shelter.
SEE ALSO: Historic Fourth of July fireworks to light up National Mall: How to watch live
The DC Homeland Security & Emergency Management released a list of places where the crowds can go to get out of the weather:
Federal Buildings:
- Ronald Reagan Building – 100 Pennsylvania Ave NW
- Dept. of Commerce – 1401 Constitution Ave NW
- Dept. of Agriculture – 1400 Independence Dr SW
- Dept. of Education – 400 Maryland Ave SW
- Internal Revenue Service – 1111 Constitution Ave NW
- Voice of America – 330 Independence Ave SW
- Thomas Jefferson Memorial – 16 E Basin Dr SW
Museums:
- National Museum of American History – 1300 Constitution Ave NW
- National Museum of Natural History – 1000 Constitution Ave NW
- National Museum of African American History and Culture – 1400 Constitution Ave NW
Freedom 250 organizers released this statement:
“The safety of our guests, performers, and staff is our top priority. Due to approaching severe storms, Freedom 250, United States Secret Service, United States Park Police, National Park Service, the Federal Emergency Management Agency, and all public safety partners are asking all guests to evacuate event grounds and seek temporary shelter in a nearby building. Available shelter locations include the Department of Commerce, Department of Education, Department of Agriculture, Internal Revenue Service, VOA Building, Thomas Jefferson Memorial, National Museum of American History, National Museum of Natural History, the African American Museum, and the Ronald Reagan Building. Please remain calm, follow the directions of law enforcement and event staff, and stay tuned to Freedom 250’s official channels for updates. Freedom 250 will share updates on programming and doors reopening — please stay close to our official channels for updates.”
The Secret Service said they have suspended screening on the National Mall.
“Security screening on the National Mall has been suspended due to dangerous storms,” the Secret Service said. “If you are already on the grounds, follow directions from officers and event staff and move to shelter immediately. Do not shelter under trees.”
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Metro riders are also asked to seek shelter. Commuters should expect heavy crowds at stations near the National Mall and are asked to consider using L’Enfant Plaza, Metro Center, Archives, Federal Triangle or Federal Center SW stations to avoid congestion.
The nation’s capital may be the focal point of the 250th Independence Day celebration, but people all across America have plans to mark the occasion, from boisterous public parades to quiet personal reflections on history.
Julia Demaree Nikhinson/AP
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Julia Demaree Nikhinson/AP
As the United States turns 250 years old, Americans across the country are spending the holiday thinking about what the big birthday means to them, with reflections and celebrations as diverse as the nation itself.
NPR’s member station reporters fanned out to collect snapshots of the occasion from sea to shining sea.
In one ‘City of Presidents,’ Main Street is decorated for a party
At least two cities in the U.S.call themselves the “City of Presidents” and Cuba City, in Wisconsin, is one of them, largely due to its patriotic Main Street decorations. Every year from Memorial Day through Veteran’s Day, red, white, and blue shields, one for each U.S. president, are prominently displayed high up on the light poles lining Main Street.
It’s a tradition that began in 1976 to commemorate the country’s bicentennial, says Donna Rogers, who is president of the ongoing project but admitted that when it first started, she wasn’t particularly tuned-in to the display.
“I was raising three little boys and working at John Deere, so I didn’t really pay too much attention to community service at that time,” she said.
Donna Rogers shows off one of Cuba City’s presidential lampposts.
Susan Bence/WUWM
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Susan Bence/WUWM
A few years later, she was tapped to help keep the initiative alive.
When she thinks of the country’s history, she says the signing of the Declaration of Independence and abolition of slavery top her list, plus a current event–
“Of course, now, our nation’s 250th birthday. I think those three would be the three most important things in history to me,” she said, quickly adding “[the] right for women to vote, don’t forget that, right?”
Rogers and Cuba City are pulling out all the stops for the 250th, with a parade and a mac-and-cheese festival, because “that was some of our founding fathers favorite foods, along with turkey and cranberries and other items.”
She laughed and admitted she googled that. True or not, Rogers says they’ll go all-out to celebrate the 250th in her “City of Presidents”.
WUWM’s Susan Bence reported from Cuba City, Wisconsin.
In Georgia, a civics competition inspires hope for future generations
At the Georgia state finals of the National Civics Bee, middle school students were peppered with questions about the U.S. government.
Like this one: why is a single energetic executive desirable?
The answer: it promotes accountability and decisive leadership.
9th grader Ella Hummel got it right.
“I’ve always kind of had the idea of serving in politics,” she said after the competition. “And I really think that civics has opened my mind.”
Ella will advance to the civics bee finals later this fall, with her grandmother, Peggy Farmer, cheering her on. Farmer remembers the excitement around the bicentennial in 1976, but said she feels a different energy around this year’s anniversary.
“It’s a togetherness type of thing that’s really not around all the time now,” she mused. “I think it’s just the world’s changed a lot.”
But there is something Farmer will celebrate about America on this Independence Day: her grandkid, the Georgia Civics Bee Champion.
“Maybe she and the kids that was sitting up there, they can change [the country] a little bit. I mean, they seem to be having a ball with each other up there today, so that’s a good thing.”
GPB’s Sofi Gratas reported from Atlanta.
In Texas, appreciating the process of patriotism
Rodney Ellis, who has served 43 years in public office, is guardedly optimistic that America will stay on a path towards progress.
John Burnett
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John Burnett
Rodney Ellis will celebrate at picnics around his precinct in Houston with barbecue pork ribs and ice tea, and a heaping helping of worry about the nation’s future. The tall, garrulous 72-year-old county commissioner is guardedly patriotic.
“We should be celebrating that America is a process,” he said. “Patriotism is telling the truth, and doin’ the work to repair the harms that have come about over these 250 years.”
The son of a maid and a landscaper, Ellis has served 43 years in public office, first as a Houston city councilman, then state senator, and now as a Harris County commissioner.
Fifty years ago, during the bicentennial, Ellis was a public affairs graduate student at the University of Texas in Austin. In 1976, there were 18 Black representatives in Congress; today there are 67.
“We’ve made tremendous progress since then, tremendous gains,” he said. “And so when I compare what was happening then to what’s happening now, I look at how quickly a lot of those fundamental rights, those gains that we’ve taken for granted have rolled back so quickly.”
He ticked off areas where he believes America has lost ground: clean air and clean water, people of color in key positions in government, owning up to uncomfortable U.S. history, and selfless public service.
But, said the commissioner with a broad grin, that’s how it’s always been in America.
“Progress is made but along the way sometimes you take two steps forward and 10 steps back, but you don’t give up.”
John Burnett reported from Houston, TX.
In Milwaukee, Fourth of July tacos with a big helping of pride
Gissell Vera is proud to be both American and Mexican. She plans to celebrate both of her cultures with a Fourth of July carne asada cookout.
Maayan Silver/WUWM
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Maayan Silver/WUWM
Gissell Vera ordered carne asada tacos on her favorite patio in Milwaukee, a vibrant spot punctuated with strings of international flags and a steady cumbia drumbeat.
“The music, the colors, the language, all of it is part of me and I am a proud American,” she said.
Vera is a U.S. citizen from a mixed status family; her parents emigrated from Veracruz, Mexico.
“My family has particularly always been grateful for this country and the opportunities that it’s provided us,” said the 25 year-old. “Although there is always the fear and uncertainty of what immigration reform could, how it could impact us, we choose to live every day without fear.”
Vera said there’s a phrase she’s heard many immigrants use to describe their relationship to the United States, “ni de aquí ni de allá,”, meaning ‘neither from here or there.’
“It’s almost like a limbo in which we existed,” she explained. “And I think that now I’m very proud to say that I am ‘de aquí’ and ‘de allá’. So I am proud to be from here and from there.”
She said she’ll join her family for a cookout to celebrate America’s 250th birthday, but instead of hot dogs, they’ll be grilling carne asada.
WUWM’s Maayan Silver reported from Milwaukee.
In the Mountain West, a closer look at a national myth
As America turned 250 this year, historian Megan Kate Nelson used the occasion to take a closer look at a foundational myth of the country’s history and ask, “what stories do we carry forward?”
Her new book ‘The Westerners’ profiled pioneers who, according to Nelson, don’t fit “the narrative of white Easterners moving westward in covered wagons with a nuclear family in tow, engaging with a series of challenges.”
A statue of Sacagawea along the banks of the Missouri River in Great Falls, Mont. Sacajawea was a Lemhi Shoshone woman, who accompanied Lewis and Clark as an interpreter and guide. Her role in the expedition is reexamined in Megan Kate Nelson’s book.
Matt Volz/AP
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Matt Volz/AP
That includes historical figures like Polly Bemis, who was trafficked from China to the Idaho frontier, and María Gertrudis Barceló, a Santa Fe saloon owner and professional gambler.
Even the well-known figure, Sacagawea, gets another look.
“I read through the Lewis and Clark journals. They mention her more than 150 times, and she is always doing something or saying something,” said Nelson. “My favorite part: when they arrive on the western coast, they set up camp a couple miles away from the ocean, and she yells at William Clark. ‘You are going to take me to go see the ocean! I did not travel all this way not to see the ocean!’”
Nelson said it’s more important than ever to elevate a fuller picture of westward expansion, and to challenge the frontier myth that “there’s only one white pioneer; there’s only one kind of story of American greatness.”
Ryan Warner reported from Crested Butte, Colorado.
In Rhode Island, the parade is nearly as old as the nation itself
Every Independence Day, the yellow stripes dividing Hope Street get a patriotic makeover.
David Wright/Ocean State Media
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David Wright/Ocean State Media
The town of Bristol, Rhode Island, lays claim to the nation’s oldest Independence Day celebration. This year, they will celebrate America’s 250th with their 241st birthday bash for the country, an effort that brought together over 100 volunteers as part of the Fourth of July committee.
Plans include a parade with at least 34 floats, a golf tournament, a “Miss Fourth of July” beauty pageant, and a gala ball.
Even the double yellow line down Hope Street got its annual red, white and blue makeover for the parade.
For the past decade, Heidi Vermilyea has been in charge of the parade souvenirs, selling hats, t-shirts, and Christmas tree ornaments out of a blue trailer.
“I think I’ve missed the parade once when I was in Europe for the Fourth of July,” Vermilyea admits. “But otherwise, I have been either watching the parade or working the parade my whole life.”
Even when she’s not working the events, she’s decked out in stars-and-stripes, all the way down to her patriotic pedicure.
Heidi Vermilyea runs the souvenir truck for Bristol’s parade every July 4th. But her American flag outfits are year-round display of her patriotism.
David Wright/Ocean State Media
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David Wright/Ocean State Media
“Politics you can be left, right, moderate, whatever,” Vermilyea explains. “Patriotism is just loving your community. Helping out to make your community, your country a better place.”
The way she sees it, she’s flying the flag for Bristol, her family and friends.
This story was reported by Ocean State Media’s David Wright.
In Oregon, grappling with a complicated history
Some of Mitchell S. Jackson’s fondest childhood memories are of the Fourth of July.
“My mother would always buy me an outfit that had a red, white, and blue color scheme,” Jackson, who is now 50 years old, remembered. “And it was joyous, you know, to don those colors.”
But as the Pulitzer Prize-winning writer grew up, he learned more about America’s history of slavery and racism. Jackson said that made his relationship to his country more complicated, especially after he was convicted on drug and weapons charges as a 21-year-old and imprisoned for over a year.
“I lost my right to vote before I ever voted, before it ever dawned on me that my suffrage was important,” remembers Jackson. “And I would say that that is an American project, that a young Black boy loses his right to vote.”
Jackson said these inequalities, both historical and modern, call into question the very anniversary we’re celebrating.
“When I hear 250, I know that that’s a false number, right?”
Mitchell S. Jackson at the 60th anniversary of the March on Washington. For Jackson, the 250th is not a true celebration of American freedom, since so many people were enslaved at the time.
Erwin JT Trollinger
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Erwin JT Trollinger
Jackson said that to him, true freedom in America only goes back 160 years, to when the 14th amendment granted everyone equal protection under the law. Or even just 62 years to the Civil Rights Act, which outlawed segregation.
“If you love something, you’re also critical of it,” he pointed out. “You don’t just love it blindly, or I hope you don’t just love it blindly. So if you truly love America, then you gotta tell the truth about America.”
Jackson says there are ways for Black Americans to make the Fourth of July, and America itself, their own. But it’s a group project to understand who we are, and who we’ve been, and who we can become.
Deena Prichep reported from Portland, Oregon.
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