Cognitive Aging, Brain Morphology, and Arrhythmias in Hispanics/Latinos: Implications for Prevention and Management of Alzheimer's Disease-Related Dementias

西班牙裔/拉丁裔的认知衰老、大脑形态和心律失常：对预防和管理阿尔茨海默病相关痴呆的影响

• 批准号: 10448081
• 负责人: Lin Yee Chen
• 金额: $ 413.14万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448081
• 关键词: Accelerometer; Address; Adult; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Ancillary Study; Arrhythmia; Atrial Fibrillation; Black Populations; Black race; Blood Pressure; Brain Infarction; Cardiac; Cardiovascular Diseases; Cerebrovascular Trauma; Clinical; Cognitive aging; Communities; Data; Dementia; Disease; Elderly; Electrocardiogram; Epidemiologic Methods; Ethnic group; Frequencies; Future; Goals; Hispanic; Hispanic Community Health Study/Study of Latinos; Hispanic Populations; Imaging technology; Impaired cognition; Incidence; Individual; Ischemic Stroke; Knowledge; Latino; Latino Population; Life Style; Longevity; Magnetic Resonance Imaging; Measures; Minority Groups; Minority Health Research; Monitor; Neurocognitive; Obesity; Participant; Pattern; Persons; Physical activity; Population Heterogeneity; Prevalence; Prevention; Prevention strategy; Public Health Practice; Research; Risk; Risk Factors; Structure; Supraventricular Arrhythmia; United States National Institutes of Health; Ventricular Arrhythmia; Visit; adjudicate; analytical method; base; brain magnetic resonance imaging; brain morphology; brain volume; cardiac magnetic resonance imaging; cardiovascular disorder risk; clinical practice; cognitive function; cohort; dementia risk; executive function; health disparity; heart rhythm; high risk; middle age; mild cognitive impairment; neuroimaging; neurovascular unit; novel; prevention clinical trial; symposium; vascular cognitive impairment and dementia; vascular injury; wearable device

Alzheimer’s Disease (AD) and AD-Related Dementias (ADRD) are projected to affect 115 million people worldwide by 2050. Vascular contributions to cognitive impairment and dementia (VCID)—a primary type of ADRD—is a major research focus for the NIH, which has called for the need for studies of prevention across the lifespan and in diverse populations (ADRD summit 2019). Underrecognized but relevant to VCID, prior research indicates that arrhythmias are associated with lower cognitive function and greater risk of AD/ADRD. However, current knowledge of arrhythmias’ neurocognitive impact is lacking in the fastest growing ethnic group in the USA—Hispanics/Latinos—who are anticipated to contribute disproportionately to the projected increase in prevalence of mild cognitive impairment (MCI) and ADRD. Thus, robust and comprehensive data on prevalence and neurocognitive impact of arrhythmias in Hispanics/Latinos are critically needed. Furthermore, from a prevention standpoint, although prior research shows that modifiable lifestyle and cardiovascular disease (CVD) risk factors are related to ADRD risk and arrhythmia risk and burden, it is unknown whether optimizing lifestyle/CVD risk factors can mitigate the arrhythmia-ADRD relationship. To address the foregoing knowledge gaps, we will apply the ZioXT Patch—a non-invasive ambulatory continuous ECG monitor—to ~5,000 participants (age ≥45 years) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) in 2022-24 (concurrent with Visit 3) and leverage the rich data in HCHS/SOL and related ancillary studies: neurocognitive assessment, adjudicated MCI and ADRD, brain MRI, cardiac MRI, lifestyle/CVD risk factors including 7-day accelerometer-based physical activity, adiposity measures, and blood pressure. We hypothesize that in Hispanic/Latino adults, higher arrhythmia frequency will be associated with higher incidence of MCI or ADRD, greater cognitive decline, more brain infarcts and small vessel ischemic disease, and lower brain volumes. These associations will be independent of CVD and cardiac structure/function and will be more evident in those with less optimal (vs. more optimal) lifestyle/CVD risk factor trajectories. We will evaluate these aims: Aim 1: Define the prevalence and frequency of arrhythmias in Hispanic/Latino adults using ambulatory heart rhythm monitoring, Aim 2: Evaluate the association of arrhythmias with change in cognitive function and incident MCI or ADRD, Aim 3: Assess the association of arrhythmias with markers of vascular brain injury based on brain MRI. Importantly, for each Aim, we will examine the consistency of associations by antecedent 10-year lifestyle/CVD risk factor trajectories. This project will combine exceptional and complementary scientific expertise, wearable and imaging technology, rigorous epidemiological and analytical methods, and leverage an existing NIH cohort to refine the VCID paradigm and overcome critical barriers in AD/ADRD and minority health research, thus achieving a sustained and powerful impact on public health and clinical practice.

阿尔茨海默病 (AD) 和 AD 相关痴呆症 (ADRD) 预计将影响 1.15 亿人 到 2050 年，血管会导致认知障碍和痴呆 (VCID)——一种主要类型 ADRD——是 NIH 的一个主要研究重点，它呼吁需要进行跨领域的预防研究 寿命和不同人群（ADRD 峰会 2019）尚未得到充分认识，但与 VCID 相关，之前。 研究表明，心律失常与较低的认知功能和较高的 AD/ADRD 风险相关。 然而，目前在增长最快的种族中缺乏对心律失常对神经认知影响的了解。 美国的一个群体——西班牙裔/拉丁裔——预计他们会对预计的贡献不成比例 轻度认知障碍 (MCI) 和 ADRD 患病率增加因此，数据可靠且全面。 迫切需要了解西班牙裔/拉丁裔心律失常的患病率和神经认知影响。 此外，从预防的角度来看，尽管先前的研究表明可改变的生活方式和 心血管疾病（CVD）危险因素与ADRD风险和心律失常风险和负担有关， 尚不清楚优化生活方式/CVD 危险因素是否可以减轻心律失常与 ADRD 的关系。 为了解决上述知识差距，我们将应用 ZioXT 贴片——一种非侵入性动态连续治疗 心电图监测——西班牙裔社区健康研究/研究中约 5,000 名参与者（年龄≥45 岁） 2022-24 年拉丁裔 (HCHS/SOL)（与访问 3 同时）并利用 HCHS/SOL 及相关内容中的丰富数据 辅助研究：神经认知评估、MCI 和 ADRD 判定、脑 MRI、心脏 MRI、 生活方式/CVD 风险因素，包括 7 天基于加速度计的体力活动、肥胖测量和血液 我们认为，在西班牙裔/拉丁裔成年人中，较高的心律失常频率与压力有关。 MCI 或 ADRD 发生率更高、认知能力下降更严重、脑梗塞和小血管缺血更多 疾病和脑容量降低这些关联与心血管疾病和心脏疾病无关。 结构/功能，对于那些生活方式/CVD 风险因素不太理想（相对于更理想）的人来说会更加明显 我们将评估这些目标： 目标 1：确定心律失常的患病率和频率。 使用动态心律监测的西班牙裔/拉丁裔成年人，目标 2：评估以下因素之间的关联： 心律失常伴有认知功能变化和 MCI 或 ADRD 事件，目标 3：评估以下因素之间的关联： 重要的是，对于每个目标，我们都会根据脑部 MRI 进行具有血管性脑损伤标记的心律失常。 通过先前 10 年生活方式/CVD 危险因素轨迹检查关联的一致性。 项目将结合卓越且互补的科学专业知识、可穿戴和成像技术， 严格的流行病学和分析方法，并利用现有的 NIH 队列来完善 VCID 范式并克服 AD/ADRD 和少数民族健康研究中的关键障碍，从而实现可持续发展 对公共卫生和临床实践产生巨大影响。