URBAn Native Elders (URBANE): Risk and Protective Factors for Alzheimer's and Related Dementias

城市原住民老年人 (URBANE)：阿尔茨海默病和相关痴呆症的风险和保护因素

• 批准号: 9811142
• 负责人: Lonnie A. Nelson
• 金额: $ 150.66万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9811142
• 关键词: Acute; Address; Adult; Age; Age-associated memory impairment; Alaska Native; Alcohol consumption; Alleles; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American Indians; Area; Behavioral; Biological Markers; Brain; Brain imaging; Caring; Cerebrovascular Disorders; Cerebrovascular Trauma; Cities; Clinical; Cognitive; Cohort Studies; Communities; Cross-Sectional Studies; Data; Data Collection; Databases; Development; Diabetes Mellitus; Disease; Educational Background; Elderly; Environment; Epidemiology; Evaluation; Exclusion; Foundations; Funding; Future; Genetic Risk; Genetic screening method; Geographic Locations; Geography; Health; High Prevalence; Hypertension; Image; Imaging Techniques; Impaired cognition; Influentials; Institutes; Intervention; Kidney Diseases; Life Expectancy; Life Style; Longitudinal Studies; Longitudinal cohort study; Low Prevalence; Magnetic Resonance Imaging; Measures; Mediation; Mediator of activation protein; Medical Genetics; Motor; National Institute on Aging; Native-Born; Neurocognitive; Neuropsychology; Non-Insulin-Dependent Diabetes Mellitus; Oklahoma; Participant; Pathology; Physical Function; Pilot Projects; Population; Preparation; Prevalence; Prospective cohort study; Protocols documentation; Psyche structure; Public Health; Publications; Race; Reporting; Research; Research Personnel; Reservations; Resources; Risk; Risk Factors; Rural; Sampling; Seminal; Source; Stroke; Testing; Transient Ischemic Attack; Traumatic Brain Injury; Tribes; Urban Health; White Matter Hyperintensity; Woman; Work; aged; base; cerebral atrophy; clinical risk; cognitive function; cohort; comparative; disorder risk; education access; experience; health care availability; higher education; innovation; lifestyle factors; low socioeconomic status; medical specialties; men; metropolitan; native elder; neuroimaging; novel; performance tests; pre-clinical; prevent; protective effect; protective factors; recruit; rural Americans; rural area; sex; urban Native American; urban area

ABSTRACT: Alzheimer’s disease and related disorders (ADRD) is a growing public health concern for American Indian and Alaska Native (AI/ANs) people, but AI/ANs are profoundly underrepresented in ADRD research. For example, the National Alzheimer’s Coordinating Center database, an important resource for influential ADRD studies, includes just 162 AI/ANs out of 31,000 adults (0.5%). This is a troubling exclusion, since AI/ANs have high burdens of many ADRD risk factors, including hypertension, type 2 diabetes, traumatic brain injury, vascular brain injury (VBI), and stroke. The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) study, conducted by our research group, is the only prospective cohort study with longitudinal data for rigorous evaluation of cognitive function, ADRD, and VBI in any US Native population. In its first wave of exams, CDCAI collected data on 818 elderly AI/ANs living on reservations in 3 primarily rural, geographic regions; the second wave of exams is underway. CDCAI is yielding seminal findings on ADRD risk factors and biomarkers in AI/ANs; 33% of the sample showed evidence of VBI, with men even higher. Yet the cohort is not representative of the national AI/AN population because 72% of AI/ANs now reside in urban areas. Urban A/ANs represent an “invisible tribe” that is largely absent from health research. One likely explanation is that urban environments feature distinctive risk and protective profiles, including lifestyle factors that exacerbate age-related cognitive decline, and protective factors such as better access to acute and specialty care and higher levels of education. Accordingly, we propose a novel study, URBan Native Elders (URBANE), to replicate CDCAI in a large cohort of urban AI/ANs with broad geographic representation. We will recruit 1,200 men and women ages 55 and older in 5 geographically diverse metropolitan areas with large AI/AN populations. Data collection will include MRI for all participants, and genetic testing for alleles associated with ADRD in the all-races population. We will expand CDCAI protocols to reflect state-of-the- art imaging and neuropsychological assessments. We will use protocols established by the CDCAI to estimate probable ADRD based on a single exam. The resulting analyses will establish the baseline prevalence of cognitive impairment, probable ADRD, and VBI and their associations with clinical, genetic, neuroimaging, behavioral, and lifestyle risk and protective factors. Of importance, this cross-sectional study will lay the foundation for future longitudinal research on ADRD. Our Specific Aims are to: Quantify the extent of probable ADRD and VBI as defined by brain MRI, and determine their associations with cognitive functioning in a diverse sample of urban AI/AN elders. 2) Evaluate associations between conventional risk factors and probable ADRD, and evaluate potential mediation of selected risk factors by VBI. 3) In an exploratory analysis, evaluate potential differences in our primary associations by sex; and evaluate education and access to healthcare as potential protective factors for cognitive impairment and probable ADRD in elders with VBI.

摘要：阿尔茨海默病及相关疾病 (ADRD) 是美国人日益关注的公共卫生问题。 印第安人和阿拉斯加原住民 (AI/AN) 人，但 AI/AN 在 ADRD 研究中的代表性严重不足。 例如，国家阿尔茨海默病协调中心数据库，是有影响力的 ADRD 的重要资源 研究仅包括 31,000 名成年人中的 162 名 AI/AN（0.5%），这是一个令人不安的排除，因为 AI/AN 的死亡率很高。 许多 ADRD 危险因素的负担，包括高血压、2 型糖尿病、创伤性脑损伤、血管性脑损伤 损伤（VBI）和中风美国印第安人的脑血管疾病及其后果（CDCAI）研究， 由我们的研究小组进行的，是唯一一项使用纵向数据进行严格评估的前瞻性队列研究 在第一波测试中，CDCAI 收集了所有美国原住民的认知功能、ADRD 和 VBI 的数据。 对居住在 3 个主要农村地理区域的 818 名老年 AI/AN 进行第二波检查； CDCAI 正在对 AI/AN 中的 ADRD 风险因素和生物标志物产生开创性的发现； 显示了 VBI 的证据，其中男性甚至更高，但该队列并不能代表全国 AI/AN 人群。 因为 72% 的 AI/AN 现在居住在城市地区，这是一个基本上不存在的“隐形部落”。 一种可能的解释是，城市环境具有独特的风险和保护性。 概况，包括加剧与年龄相关的认知能力下降的生活方式因素，以及保护性因素，例如 因此，我们提出了一项新颖的研究， 城市原住民长者 (URBANE)，将 CDCAI 复制到一大群具有广泛地理范围的城市 AI/AN 中 我们将在 5 个不同地域的大都市招募 1,200 名 55 岁及以上的男性和女性。 具有大量 AI/AN 人口的区域的数据收集将包括对所有参与者进行 MRI 以及对所有参与者进行基因检测。 我们将扩展 CDCAI 方案以反映最新情况。 我们将使用 CDCAI 制定的协议进行评估。 基于单次检查的可能 ADRD 分析结果将确定认知的基线患病率。 损伤、可能的 ADRD 和 VBI 及其与临床、遗传、神经影像、行为和 重要的是，这项横断面研究将为未来奠定基础。 ADRD 的纵向研究我们的具体目标是： 将可能的 ADRD 和 VBI 的程度量化为 由大脑 MRI 定义，并确定它们与不同城市样本中认知功能的关联 AI/AN 老年人 2) 评估传统危险因素与可能的 ADRD 之间的关联，并评估 VBI 对选定风险因素的潜在调节 3) 在探索性分析中，评估以下方面的潜在差异。 我们按性别划分的主要关联；并评估教育和获得医疗保健的机会作为潜在的保护因素 治疗患有 VBI 的老年人的认知障碍和可能的 ADRD。