Improving Dementia Care for Native American Elders: Evidence for Culturally Grounded Screening, Prevention, and Caregiving Interventions.

Dementia is a growing health concern among Native American elders, who face a high burden of chronic disease, socioeconomic hardship, and historical trauma. Many individuals experience delayed or missed diagnoses due to structural barriers, limited specialist access, mistrust of healthcare systems, and the absence of culturally appropriate cognitive screening tools. This narrative review summarizes current understanding of dementia prevalence, risk factors, and diagnostic challenges in Native American communities. Chronic conditions such as diabetes, hypertension, obesity, and stroke may interact with psychosocial and historical factors in ways that influence cognitive decline. Standard cognitive assessments, including the Mini-Mental State Examination (MMSE) and the clock-drawing test, may not accurately reflect cognitive function because of cultural and linguistic differences. Promising approaches include community health representative-led screening, culturally adapted assessments, community wellness initiatives, caregiver training grounded in Indigenous values, and the incorporation of traditional healing practices. Strengths-based strategies that support cultural identity and social connection may also enhance engagement in care. Significant gaps remain, including the lack of culturally validated screening tools, limited epidemiologic data, under-resourced tribal health systems, workforce limitations, and inadequate telehealth infrastructure. Efforts to improve dementia care will require coordinated policy support, investment, and tribally led research. Culturally grounded, community-driven models may strengthen early detection, care coordination, and overall quality of life for Native American elders.