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.

阿尔茨海默氏病（AD）和与广告相关的痴呆症（ADRD）预计将影响1.15亿人 到2050年，全球。对认知障碍和痴呆（VCID）的血管贡献 - 主要类型 ADRD - NIH的主要研究重点 寿命和潜水员人口（2019年Adrd Summit）。未被认可，但与VCID相关，先验 研究表明，心律不齐与较低的认知功能和更大的AD/ADRD风险有关。 但是，目前对心律失常的神经认知影响的了解最快的种族缺乏 美国的小组 - 他的人/拉丁美洲人，预计将对预计的贡献不成比例 轻度认知障碍（MCI）和ADRD的患病率增加。那是强大而全面的数据 关于心律不齐在西班牙裔/拉丁美洲人的患病率和神经认知的影响。 此外，从预防的角度来看，尽管先前的研究表明，可修改的生活方式和 心血管疾病（CVD）风险因素与ADRD风险和心律不齐风险和伯恩有关，这是 尚不清楚优化生活方式/CVD风险因素是否可以减轻心律不齐的关系。到 解决上述知识差距，我们将应用Zioxt补丁 - 无创腹膜 ECG监控器 - 西班牙裔社区健康研究/研究 2022-24的拉丁美洲人（HCHS/SOL）（与访问3并发），并利用HCHS/SOL和相关的丰富数据 辅助研究：神经认知评估，调整后的MCI和ADRD，Brain MRI，心脏MRI， 生活方式/CVD风险因素，包括基于7天加速度计的体育活动，肥胖度量和血液 压力。我们假设在西班牙裔/拉丁裔成年人中，较高的心律不齐频率将与 MCI或ADRD的较高事件，认知能力下降，更多的脑部和小血管缺血 疾病和较低的大脑体积。这些关联将独立于CVD和心脏 结构/功能，将是那些最佳（与最佳）生活方式/CVD风险因素的人中更多的证据 轨迹。我们将评估这些目标：目标1：定义心律不齐的患病率和频率 西班牙裔/拉丁裔成年人使用门诊心律监测，目标2：评估 心律失常随认知功能变化和事件MCI或ADRD的变化，目标3：评估关联 基于脑MRI的血管脑损伤标记的心律不齐。重要的是，对于每个目标，我们都会 通过前十年的生活方式/CVD风险因素轨迹检查关联的一致性。这 项目将结合卓越和完整的科学专业知识，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 在AD/ADRD和少数民族健康研究中，范式和克服关键障碍，从而实现了持续的 以及对公共卫生和临床实践的强大影响。