Blood Pressure and ADRD in African Americans: the Jackson Heart Study

非裔美国人的血压和 ADRD：杰克逊心脏研究

• 批准号: 10165457
• 负责人: Priya Palta
• 金额: $ 155.49万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165457
• 关键词: Address; African American; Alleles; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer’s disease biomarker; Ambulatory Blood Pressure Monitoring; American Heart Association; Amyloid; Ancillary Study; Biological Factors; Biological Markers; Blood Pressure; Blood Vessels; Brain; Cardiology; Cardiovascular Diseases; Cardiovascular system; Cerebrovascular Disorders; Classification; Clinical; Clinical Trials; Cognition; Cognitive; Cohort Studies; Complement; Coupled; Data; Dementia; Detection; Diagnosis; Diastolic blood pressure; Elderly; Exposure to; Failure; Genetic; Genotype; Goals; Guidelines; High Prevalence; Hour; Hypertension; Impaired cognition; Individual; Intervention Trial; Jackson Heart Study; Joints; Light; Magnetic Resonance Imaging; Measures; Mediating; Mediator of activation protein; Memory; Minority Groups; National Institute on Aging; Nerve Degeneration; Outcome; Participant; Pathology; Phenotype; Plasma; Population Heterogeneity; Prevalence; Prevention; Race; Reading; Recommendation; Reporting; Research; Risk; Role; Specific qualifier value; Time; Update; White Matter Hyperintensity; Woman; adjudication; aging brain; apolipoprotein E-4; blood pressure intervention; blood pressure reduction; blood pressure variability; brain health; brain volume; cerebrovascular pathology; cognitive function; cognitive performance; cognitive testing; cohort; college; dementia risk; early onset; ethnic difference; follow-up; genetic risk factor; genetic variant; health disparity; high risk; improved; innovation; meetings; member; mild cognitive impairment; minority health; neurofilament; neuropathology; novel; policy implication; primary outcome; racial disparity; resilience; response; secondary outcome; sex; social health determinants; symposium; tau Proteins; vascular risk factor

PROJECT SUMMARY/ABSTRACT Rates of mild cognitive impairment (MCI) and dementia are two to three times higher among African Americans (AAs) than among White older adults. Observational and clinical trial data, most recently from the Systolic Blood Pressure Intervention Trial: Memory and Cognition in Decreased Hypertension (SPRINT-MIND), support that blood pressure is the most important modifiable vascular risk factor for MCI and dementia. However, the short duration of follow-up in SPRINT-MIND coupled with the failure to detect a statistically significant benefit of a lower blood pressure goal for incident dementia means that longer-term observational data will be necessary to fully address the implications of the clinical trial results. These questions are particularly salient for AAs, who have earlier onset of high blood pressure and are at higher risk of dementia, in particular cerebrovascular pathology. Even after considering race/ethnic differences in blood pressure level, the mechanisms underlying racial disparities in risk for dementia are not well understood. Additionally, despite facing a high burden of high blood pressure, some individuals are resilient, achieving better-than-expected outcomes. The specific factors that contribute to brain-health resilience are not well established. We propose to address these research gaps in an ancillary study to the 2020-2022 4th examination of ~2,700 participants in the Jackson Heart Study (JHS), an ongoing cohort study of well-characterized AAs. The JHS Exam 4 will include brain magnetic resonance imaging (MRI) data to ascertain cerebrovascular disease and neurodegeneration. We propose to add measures of cognition and function sufficient for classification of MCI and dementia, and innovative plasma biomarkers of amyloid (Ab42, Ab40), tau, and neurodegeneration (neurofilament light). The primary aims are as follows: Aim 1. Estimate the long-term associations of exposure to high 20-year time-weighted average blood pressure and blood pressure load on (1) cognitive performance; (2) prevalence of MCI and dementia; (3) markers of cerebrovascular disease and neurodegeneration quantified from MRI; and (4) plasma amyloid, tau and neurodegeneration. Aim 2. Examine whether sex, educational quality (i.e. reading level measured with the WRAT), and APOE-e4 and ABCA7 genotype, modify the associations of long-term exposure to high blood pressure and blood pressure load with cognitive outcomes. This study is responsive to PAR-19-070 and NOT- AG-18-047 (Health Disparities and Alzheimer’s Disease) by adding cognitive assessments to a landmark cohort study of cardiovascular disease in AAs; leveraging existing and new data to understand risk and resilience factors for cognitive impairment; and drawing on the JHS cohort to understand vascular mechanisms underlying cognitive impairment in a minority population. This study is also proposed in the context of the updated National Institute on Aging/Alzheimer’s Association research framework in which the constructs of amyloid, tau, and neurodegeneration are featured prominently. Lastly, results from this study will inform future research and have implications for policies intended to improve brain aging in minority populations.

项目摘要/摘要 非裔美国人的轻度认知障碍率（MCI）和痴呆症的比例高两到三倍 （AA）比白人老年人中的。观察和临床试验数据，最近来自收缩期 血压干预试验：高血压降低（冲刺）的记忆和认知，支持 血压是MCI和痴呆症最重要的修饰血管危险因素。但是， 短暂的后续持续时间短，连同未能检测到具有统计学意义的好处 入射痴呆症的血压较低意味着需要长期观察数据 充分解决临床试验结果的含义。对于AAS，这些问题尤其重要 高血压发作较早，痴呆症的风险更高，特别是脑血管 病理。即使考虑了血压水平的种族/种族差异， 痴呆症风险的种族分布尚不清楚。此外，尽管面临高燃烧 血压，有些人具有弹性，取得了比预期的更好的结果。具体因素 这有助于脑部健康的弹性。我们建议解决这些研究差距 在2020-2022的辅助研究中，对杰克逊心脏研究（JHS）的约2,700名参与者进行了第四次检查， 一项持续良好特征的AA的队列研究。 JHS考试4将包括大脑磁共振 成像（MRI）数据以确定脑血管疾病和神经退行性。我们建议添加 认知和功能的度量足以分类MCI和痴呆，以及创新的等离子体 淀粉样蛋白（AB42，AB40），TAU和神经变性（神经丝光）的生物标志物。主要目的是 如下所示：目标1。估计暴露于高20年平均水平的长期关联 血压和血压负荷（1）认知表现； （2）MCI和痴呆症患病率； （3） 根据MRI定量的脑血管疾病和神经退行性的标记； （4）血浆淀粉样蛋白，tau 和神经变性。目标2。检查性别，教育质量是否（即阅读水平 WRAT），APOE-E4和ABCA7基因型，修改了长期暴露于高血的关联 压力和血压负荷具有认知结果。这项研究对Par-19-070的反应敏感，而不是 AG-18-047（健康差异和阿尔茨海默氏病）通过在地标上添加认知评估 AAS中心血管疾病的队列研究；利用现有数据和新数据了解风险和 认知障碍的弹性因素；并利用JHS队列来了解血管机制 少数族裔人口的认知障碍的基本障碍。这项研究也提出了 更新了有关老龄化/阿尔茨海默氏症协会研究框架的国家研究所 淀粉样蛋白，tau和神经变性是显着的。最后，这项研究的结果将为未来提供信息 研究并对旨在改善少数族裔大脑衰老的政策具有影响。