Executive Summary for the Road Map for Indian Country Healthy Brain Initiative

Learn. Plan. Respond to Dementia.

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The population of older American Indians and Alaska Natives (AI/ANs) is growing — and quickly. Between 2014–2060, the number of AI/ANs aged 65 and older living with dementia is projected to grow over five times. These longer lives give more time for older generations to share knowledge and traditions with the next. But greater age brings increased risk for Alzheimer’s and other dementias — when memory and thinking problems interfere with daily life and activities.

The impact of dementia is felt by multiple generations. People living with this chronic condition gradually needmore help caring for themselves including help managing medications, bathing and feeding, paying bills and cleaning, or help going to appointments or social events. Family members, from the young to the old, play a vital role in providing this care to relatives with dementia which can grow more intense over time. But there are ways to lessen this impact. More education about dementia and increased support throughout the community can help both people with dementia and caregivers stay as healthy as possible. And, traditional wellness practices and public health efforts that control high blood pressure and diabetes are ways to reduce the risk of dementia across generations.

What can tribal leaders and tribal health and aging professionals do to promote wellness among elders, including those affected by dementia? How can they support family care and prepare their communities for the future?

The Healthy Brain Initiative’s (HBI) Road Map for Indian Country is a guide for AI/AN leaders to learn about dementia and start discussions throughout their communities. The guide suggests eight strategies that embrace community strengths, including traditional practices, resilience, and existing services. The strategies can be tailored to unique priorities of each community. Educational materials from the Alzheimer’s Association, the Centers for Disease Control and Prevention, and others can make it easy to get started.

Discover how to strengthen the well-being of older adults and families dealing with dementia and to protect future generations. Get the Road Map and find helpful tools at::

  • cdc.gov/aging
  • alz.org/publichealth/indiancountry

The impact of Alzheimer’s will only continue to grow. AI/AN leaders can use the Road Map for Indian Country to learn about Alzheimer’s, find out what some AI/AN communities are doing, plan their response, and start taking action throughout their own community.


  • The number of older American Indians and Alaska Natives (AI/ANs) is increasing. An estimated 569,000 AI/ANs are aged 65 or older. This number is expected to triple over the next three decades.
  • The number of AI/ANs living with dementia is also expected to increase. Between 2014-2060, the number of AI/ANs aged 65 and older living with dementia is projected to grow over five times.
  • In 2015-2017, one in six AI/ANs aged 45 and older reported subjective cognitive decline (SCD), which are self-reported difficulties in thinking or remembering. Nearly two-thirds (63%) of those with SCD had to give up some day-to-day activities because of these cognitive problems.
  • With dementia, it’s not just the person with cognitive challenges dealing with the condition. Family members and friends feel the impact too.


Dementia is a chronic condition that affects a person’s brain. People with dementia have a variety of cognitive problems with memory, thinking, communication, and carrying out everyday tasks. Dementia gets worse over time, and people gradually lose their ability to take care of themselves. It can be difficult to provide care for people with dementia, especially when they need many hours of care over multiple years.

Alzheimer’s is the leading cause of dementia. Alzheimer’s is a disease that damages and destroys brain cells over time. Vascular dementia is the second most common cause of dementia. Vascular dementia is caused by conditions or lifestyle behaviors, such as smoking cigarettes or not being active, that weaken or block blood flow the brain.

The Alzheimer’s Association and Centers for Disease Control and Prevention also have a companion guide for state and local public health officials: HBI State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map.


The Healthy Brain Initiative’s Road Map for Indian Country is tailored for leaders of American Indian and Alaska Native (AI/AN) communities as they develop a broad response to Alzheimer’s and other dementias. The following eight public health strategies can inform and shape that response. Tribal leaders are encouraged to discuss these strategies with their community and involve members in planning and implementing these community-wide approaches.


  1. Work with community members to understand brain health, early warning signs of dementia, and benefits of early detection and diagnosis for persons with dementia and their caregivers.
  2. Encourage community members to use effective interventions, best practices, and traditional wellness practices to protect brain health, address cognitive impairment, and support persons with dementia and their caregivers.
  3. Provide information and tools to help older adults with dementia and their caregivers anticipate and respond to challenges that typically arise during the course of dementia.
  4. Promote engagement among tribal leaders in dementia issues by offering information and education on the basics of cognitive health and impairment, the impact of dementia on caregivers and communities, and the role of public health approaches in addressing this priority problem.


  1. Support collection and use of local data on dementia and caregiving in AI/AN communities to plan programs and approaches.
  2. Promote the inclusion of healthcare quality measures that address both cognitive assessments and the delivery of care to AI/ANs with dementia.

Strengthen and Purpose

  1. Educate healthcare and aging services professionals in Indian Country about the signs and symptoms of dementia and about caregiving for persons with dementia.
  2. Educate healthcare and aging services professionals on the best ways to support families and caregivers of older adults with dementia.


The Alzheimer’s Association has an online resource library (alz.org/publichealth) with background information, case studies, data, and tools that could be adapted to implement Road Map strategies.

The CDC Healthy Aging Data Portal (cdc.gov/aging) provides data on key indicators of health and well-being, screenings and vaccinations, and cognitive and mental health among older AI/AN populations.

Communications resources tailored to Indian Country are also available on the Association of State and Territorial Health Officials (ASTHO) website at astho.org/healthy-aging/healthy-heart-healthy-brain


The Healthy Brain Initiative’s (HBI) Road Map for Indian Country was shaped by many experts and leaders throughout Indian Country who provided guidance, reviewed documents, and shared their experience addressing dementia and helping caregivers. These AI/AN leaders recognized Alzheimer’s and other dementias as a serious and growing problem. They wanted to learn more about dementia and ways to promote wellness across generations and prepare for the future. This expert input helped shape the Road Map for Indian Country into a guide that AI/AN communities could tailor and generate their own solutions based on the community’s priorities and unique heritage.

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Disclaimer: The mark “CDC” is owned by the U.S. Department of Health and Human Services (HHS) and is used with permission. Use of this logo is not an endorsement by HHS or the Centers for Disease Control and Prevention (CDC) or any particular product, service, or enterprise.