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

基本信息

批准号：
9891658
负责人：
Priya Palta
金额：
$ 157.42万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
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/9891658
关键词：
Address African American Alleles Alzheimer&apos s Disease Alzheimer&apos 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 National Institute on Aging Nerve Degeneration Outcome Participant Pathology Phenotype Plasma Population 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 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

项目摘要

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.

项目概要/摘要非裔美国人轻度认知障碍 (MCI) 和痴呆症的发病率高出两到三倍（AA）高于白人老年人的观察和临床试验数据，最近来自收缩期。血压干预试验：降低高血压的记忆和认知 (SPRINT-MIND)，支持血压是 MCI 和痴呆症最重要的可改变血管危险因素。 SPRINT-MIND 的随访时间较短，并且未能检测到统计上显着的益处针对痴呆症的较低血压目标意味着需要长期观察数据充分解决临床试验结果的影响，这些问题对于 AA 来说尤其突出。高血压发病较早，患痴呆症的风险较高，尤其是脑血管病即使考虑了血压水平的种族/民族差异，其背后的机制也是如此。此外，尽管面临着高负担，但痴呆症风险的种族差异尚不清楚。血压，一些人有弹性，取得了比预期更好的结果。我们建议弥补这些研究空白。在杰克逊心脏研究 (JHS) 的 2,700 名参与者参加的 2020-2022 年第四次检查的辅助研究中，正在进行的一项针对特征明确的 AA 的队列研究将包括脑磁共振。我们建议添加用于确定脑血管疾病和神经退行性疾病的成像（MRI）数据。足以对 MCI 和痴呆进行分类的认知和功能测量，以及创新血浆淀粉样蛋白（Ab42、Ab40）、tau 蛋白和神经变性（神经丝光）的生物标志物主要目标是。如下：目标 1. 估计与 20 年时间加权平均值较高的风险敞口的长期关联血压和血压负荷对 (1) 认知能力的影响；(2) MCI 和痴呆的患病率；通过 MRI 定量脑血管疾病和神经退行性变的标志物；以及 (4) 血浆淀粉样蛋白、tau 蛋白目标 2. 检查性别、教育质量（即阅读水平）是否与 WRAT）以及 APOE-e4 和 ABCA7 基因型，改变了长期暴露于高血脂的关联压力和血压负荷与认知结果的关系本研究响应 PAR-19-070 和 NOT-。 AG-18-047（健康差异和阿尔茨海默病）通过在里程碑中添加认知评估 AA 中心血管疾病的队列研究队列；利用现有数据和新数据来了解风险和风险认知障碍的恢复力因素；并利用 JHS 队列来了解血管机制这项研究也是在少数群体中潜在的认知障碍的背景下提出的。更新了国家老龄化研究所/阿尔茨海默氏症协会的研究框架，其中的构建最后，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群体大脑老化的政策产生影响。