Reducing Disparities in Dementia and VCID Outcomes in a Multicultural Rural Population

减少多元文化农村人口中痴呆症和 VCID 结果的差异

• 批准号: 10468862
• 负责人: James E Galvin
• 金额: $ 216.56万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-06 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10468862
• 关键词: Affect; African American; African American population; African Caribbean; Age; Alcohol abuse; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Area; Behavioral Genetics; Biological; Biological Markers; Blood; Blood Vessels; Caregiver Burden; Caring; Characteristics; Chronic Disease; Clinical; Clinical Trials; Cognition; Cognitive; Communities; Coronary heart disease; County; Cross-Sectional Studies; Cultural Characteristics; Cultural Diversity; DNA; Dementia; Detection; Diabetes Mellitus; Diagnosis; Diagnostic tests; Disease; Early Diagnosis; Early treatment; Education; Elderly; Environment; Ethnic Origin; Face; Future; Genetic; Genetic Determinism; Genetic Markers; Genotype; Goals; Health; Health Care Costs; Health Services Accessibility; Healthcare; Hispanic; Hispanic Populations; Hour; Hyperlipidemia; Hypertension; Immigration; Impaired cognition; Incidence; Individual; Institutionalization; Lead; Longitudinal Studies; Medically Underserved Area; Medicare; Migrant; Minority; Modeling; Needs Assessment; Obesity; Outcome; Participant; Persons; Pharmaceutical Preparations; Phenotype; Play; Population; Population Study; Poverty; Prevalence; Race; Reduce health disparities; Risk; Role; Rural; Rural Population; Sample Size; Sampling; Specialist; Stroke; Substance abuse problem; Symptoms; Testing; Time; Work; beneficiary; brain health; cognitive performance; cohort; comorbidity; cost; dementia risk; disparity reduction; follow-up; genetic risk factor; health disparity; health literacy; health professional shortage areas; innovation; interest; lifestyle factors; low socioeconomic status; medical specialties; metropolitan; mild cognitive impairment; multiple chronic conditions; normal aging; nutrition; psychosocial; public health relevance; recruit; rural area; rural setting; rurality; sex; social; suburb; suburban communities; tobacco abuse; trait; vascular cognitive impairment and dementia; vascular risk factor

ABSTRACT Alzheimer's disease and related dementias (ADRD) affect millions of Americans. Persons living in rural areas face increased prevalence (OR=1.1) and incidence (OR=1.2) of ADRD compared to urban/suburban dwellers with increased disparities affecting health outcomes. Underlying factors that may increase ADRD risk and disparities in health outcomes include: poverty; low education; poor health literacy; poor nutrition; tobacco, alcohol and substance abuse; limited access to care (specialists, diagnostic testing); migrant or marginal immigration status; and non- and underinsurance. In addition to rurality, race and ethnicity may play a role in ADRD. African Americans are 2 times as likely and Hispanics are 1.5 times more likely than Whites to develop ADRD that may be due to different risk profiles, particularly vascular risks. These social, biologic, and genetic determinants increase risk for multiple chronic conditions associated with vascular contributions to cognitive impairment and dementia (VCID). We propose to study health disparities associated with ADRD and more specifically VCID in culturally heterogeneous older adults living in a rural setting compared with older adults living in an urban/suburban setting. Comparison populations reside either in the (a) western rural portion of Palm Beach County, FL (locally referred to as “the Glades”) or (b) the more metropolitan and affluent coastal portion of Palm Beach County (locally referred to as “the Coast”). The overall HYPOTHESIS is that rurality, combined with low SES, cultural characteristics, vascular risk factors, environment and lifestyle factors, and genetic traits synergistically increase the risk for ADRD and in particular VCID. These same factors contribute to disparities in health outcomes for rural populations compared to similar groups of older adults from urban/suburban communities. We propose these SPECIFIC AIMS: (1) Conduct a cross-sectional, population- based study of the Glades with phenotype and genotype of participants to determine the prevalence of ADRD/VCID; (2) Conduct a longitudinal study of individuals randomly selected from Aim 1 and compare to an age- and racial/ethnicity-matched sample of suburban/urban older adults recruited for longitudinal follow-up; (3) Evaluate cross-sectional relationships at baseline, 18mos, and 36mos between clinical, functional, psychosocial, genetic, and biomarker variables and cognitive performance for the cohort as a whole, and stratified by relevant biological variables; and (4) Model baseline and longitudinal clinical, functional, psychosocial, behavioral, genetic, and biomarker variables to predict cognitive impairment and rate of progression from normal cognition to MCI, and MCI to ADRD/VCID for the cohort as a whole, and stratified by relevant biological variables. Our short-term goals are to determine prevalence and profile of transition from normal aging to ADRD/VCID, in a rural population compared to urban/suburban settings; identify and characterize unique genetic and biomarker features; and explore social and biologic determinants of brain health. Our long-term goal is to reduce health disparities.

抽象的 阿尔茨海默氏病和相关痴呆症（ADRD）影响数百万美国人。居住在农村地区的人面对 与城市/郊区居民相比 影响健康结果的差异增加。可能增加ADRD风险和差异的基本因素 健康结果包括：贫困；低教育；健康素养差；营养不良；烟草，酒精和物质 虐待;有限的护理访问（专家，诊断测试）；移民或边际移民身份；和非 - 和 保险不足。除乡村外，种族和种族可能在ADRD中发挥作用。非裔美国人是2次 与白人相比，可能是由于风险不同的可能性的可能性和西班牙裔的可能性是白人的1.5倍。 轮廓，尤其是血管风险。这些社会，生物学和遗传决定者增加了多个慢性的风险 与认知障碍和痴呆症（VCID）的血管贡献相关的条件。我们建议 研究与ADRD相关的健康分布，更具体地在文化异质的老年人中 与生活在城市/郊区环境中的老年人相比，生活在粗糙环境中。比较人群 居住在佛罗里达州棕榈滩县的（a）西部崎 棕榈滩县的更多大都市和情感沿海部分（当地称为“海岸”）。总体 假设是粗糙度，结合低SES，文化特征，血管风险因素，环境 和生活方式因素以及遗传特征协同增加了ADRD，尤其是VCID的风险。这些一样 与类似的老年人相比 来自城市/郊区社区。我们提出了这些具体目标：（1）进行横截面，种群 - 基于表型和参与者的基因型的Glades的基于研究，以确定ADRD/VCID的患病率； （2）对从AIM 1随机选择的个体进行纵向研究，并与年龄和年龄和年龄进行比较 招募纵向随访的郊区/城市老年人的种族/种族匹配样本； （3）评估 基线，18mos和36mos在临床，功能，社会心理，遗传， 整个同类的生物标志物变量和认知性能，并根据相关的生物学进行分层 变量； （4）模型基线和纵向临床，功能，社会心理，行为，遗传和 生物标志物变量可预测从正常认知到MCI的认知障碍和进展率，并且 MCI到整个队列的ADRD/VCID，并根据相关的生物变量进行分层。我们的短期 目标是确定从正常衰老到ADRD/VCID的过渡率和概况 与城市/郊区环境相比；识别和表征独特的遗传和生物标志物特征；并探索 大脑健康的社会和生物学决定者。我们的长期目标是减少健康差异。