Mechanisms of inequalities in ADRD risk across race and place in the Michigan Cognitive Aging Project

密歇根认知老化项目中不同种族和地区 ADRD 风险不平等的机制

• 批准号: 10662077
• 负责人: Laura B Zahodne
• 金额: $ 106.81万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662077
• 关键词: Adult; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease model; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Attenuated; Behavioral; Black Populations; Black race; Brain; Censuses; Characteristics; Childhood; Cognitive; Cognitive aging; Communities; Control Locus; Country; Data; Diet; Disadvantaged; Discrimination; Disparity; Elderly; Ensure; Family; Goals; Growth; Health; Health Services; Health Services Accessibility; Health behavior; Hippocampus; Income; Individual; Inequality; Infrastructure; Internet; Interruption; Intervention; Knowledge; Leisure Activities; Life Cycle Stages; Link; Longitudinal Studies; Magnetic Resonance Imaging; Measures; Medical; Michigan; Modeling; Neighborhoods; Neuropsychology; Outcome; Participant; Pathway interactions; Physical activity; Policies; Population; Process; Race; Recording of previous events; Religion; Reporting; Research; Resources; Risk Factors; Self Perception; Social Work; Social support; Socioeconomic Status; Thick; Time; United States; White Matter Hyperintensity; apolipoprotein E-4; attenuation; cohort; comorbidity; critical period; data archive; dementia risk; depressive symptoms; educationally disadvantaged; experience; health disparity; longitudinal analysis; low socioeconomic status; middle age; mortality disparity; novel; psychologic; psychosocial; racial disparity; racial population; recruit; resilience factor; response; social; social cohesion; social group; theories

Risk of Alzheimer's disease and related dementias (ADRD) is higher for non-Latinx Black older adults than for non-Latinx White older adults. This disparity is not fully explained by commonly measured individual risk factors such as educational disadvantage, apolipoprotein E epsilon 4, or medical comorbidities. Thus, there is a critical need to identify additional modifiable targets at multiple levels to reduce ADRD inequalities in line with NIA's Strategic Directions for Research and the NIA Health Disparities Framework. The overall goal of this longitudinal study (N=700; 50% Black) is to identify new, modifiable pathways to reduce racial inequalities in ADRD by leveraging the community-based Michigan Cognitive Aging Project (MCAP), the National Neighborhood Data Archive (NaNDA), and recently released historical data from the 1950 census. Our strong preliminary data support concurrent neighborhood socioeconomic status (nSES) as a unique driver of cognitive inequalities that operates through modifiable environmental (e.g., public infrastructure), social (e.g., discrimination), psychological (e.g., depressive symptoms), and behavioral (e.g., diet) mechanisms. The current proposal will follow MCAP participants for a critical third time point to enable latent growth curve modeling of longitudinal cognitive trajectories, expand the cohort to ensure adequate power for between and within group longitudinal analyses in the presence of racial disparities in mortality, and collect structural magnetic resonance imaging (MRI) measures of brain integrity. In addition, this proposal will collect new data on residential histories to identify life course critical periods for neighborhood level interventions, develop a novel measure of neighborhood racial income inequality that could predict ADRD risk above and beyond nSES, and reveal resilience factors among Black older adults that could interrupt ADRD risk pathways. Recent studies have linked nSES to brain and cognitive outcomes, but the mechanisms, modifiers, and intersection with racial inequalities in ADRD are not yet understood. Grounded in the bioecological model and a life course model of ADRD inequalities, our overarching hypothesis is that eliminating racial inequalities in ADRD will require interventions at multiple levels of the exposome, and the current proposal will provide actionable knowledge to guide policies and interventions.

非拉丁裔黑人老年人患阿尔茨海默病和相关痴呆症 (ADRD) 的风险高于非拉丁裔黑人老年人 非拉丁裔白人老年人。这种差异并不能用通常衡量的个人风险来完全解释 教育劣势、载脂蛋白 E epsilon 4 或医疗合并症等因素。因此，有 迫切需要在多个层面确定额外的可修改目标，以减少 ADRD 不平等 NIA 的研究战略方向和 NIA 健康差异框架。本次活动的总体目标 纵向研究（N=700；50% 黑人）旨在确定新的、可修改的途径，以减少种族不平等 ADRD 通过利用基于社区的密歇根认知老龄化项目 (MCAP)、国家 邻里数据档案 (NaNDA)，以及最近发布的 1950 年人口普查历史数据。我们的强 初步数据支持同时邻里社会经济地位（nSES）作为认知的独特驱动因素 通过可改变的环境（例如公共基础设施）、社会（例如 歧视）、心理（例如抑郁症状）和行为（例如饮食）机制。这 当前提案将跟随 MCAP 参与者关键的第三个时间点，以实现潜在增长曲线 纵向认知轨迹建模，扩大队列以确保之间和之间有足够的力量 在死亡率存在种族差异的情况下进行群体纵向分析，并收集结构性数据 磁共振成像（MRI）测量大脑完整性。此外，该提案还将收集新数据 根据居住历史来确定社区一级干预的生命历程关键时期，制定 邻里种族收入不平等的新衡量标准可以预测 ADRD 风险 nSES，并揭示了黑人老年人中可能中断 ADRD 风险路径的复原力因素。最近的 研究已将 nSES 与大脑和认知结果联系起来，但其机制、修饰因素和交叉点 ADRD 中的种族不平等问题尚不清楚。以生物生态模型和生命历程为基础 ADRD 不平等模型中，我们的总体假设是消除 ADRD 中的种族不平等将 需要在暴露组的多个层面进行干预，当前的提案将提供可操作的 指导政策和干预措施的知识。