Black Americans are more likely than white Americans to develop Alzheimer’s disease. They are less likely to be diagnosed and get treatment. The reasons are many and systemic and can be traced to American health inequities that follow Black people from birth to death. While evidence exists that certain genetic risk factors could differ by race and be a driver, the large disparities among racial groups can’t be explained just by genetics. Poor medical care throughout life, and the stress of racism, can be factors.