Risk and mechanisms of neurocognitive impairment in older HIV-infected Hispanics

老年艾滋病毒感染西班牙裔神经认知障碍的风险和机制

• 批准号: 9197338
• 负责人: Maria Marquine
• 金额: $ 18.23万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-21 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9197338
• 关键词: Accounting; Acculturation; Affect; Age; Aging; Anti-Retroviral Agents; Attention; Attenuated; Automobile Driving; Behavior; Bioethics; Biometry; Birth Place; California; Chronic Disease; Clinical; Clinical Research; Cognitive; Cognitive aging; Communication; Communities; Complex; Development; Diet; Discrimination; Disease; Elderly; Ethnic Origin; Ethnic group; Fibrinogen; Florida; Foundations; Functional disorder; Gender; Goals; HIV; HIV Infections; Health; Health behavior; Heterogeneity; Hispanics; Infection; International; Intervention; K-Series Research Career Programs; Knowledge; Language; Lead; Leadership; Learning; Longevity; Mediating; Memory; Mentored Patient-Oriented Research Career Development Award; Mentors; Metabolic syndrome; Mexican; Minority Groups; Nature; Neuraxis; Neurocognitive; Neurocognitive Deficit; Neuropsychology; Not Hispanic or Latino; Outcome; Persons; Pharmaceutical Preparations; Population; Positioning Attribute; Psychometrics; Public Health; Research; Research Infrastructure; Research Institute; Research Project Grants; Research Proposals; Research Support; Risk; Risk Factors; Role; Rosa; Scientist; Subgroup; Targeted Research; Time; Training; Training Programs; Translational Research; Universities; Wit; burden of illness; cognitive skill; design; ethnic difference; ethnic disparity; experience; health difference; health disparity; health literacy; health service use; healthy lifestyle; high risk; improved; middle age; mild cognitive impairment; multidisciplinary; neuroAIDS; neurobehavioral; prevent; programs; psychosocial; public health priorities; public health relevance; skills; unhealthy lifestyle

 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) continues to be highly prevalent and debilitating in human immunodeficiency virus (HIV) infection, particularly among older persons. Hispanics are the fastest growing segment of the older adult population in the U.S., they are disproportionately represented among cases of HIV infection, and they are at elevated risk for NCI in both HIV and older age, separately. Yet, NCI among older HIV-infected Hispanics has not been examined. This Mentored Career Development Award (K23) application is designed to develop the applicant's skills to become an independent and culturally proficient clinical scientist investigating the role of risk factors for the development of NCI associated wit combined HIV infection and aging among Hispanics. The application contains a targeted research project to examine NCI in older HIV-infected Hispanics (primarily of Mexican origin/descent) and key factors driving ethnic differences in NCI associated with HIV and aging. Elucidation of psychosocial and biomedical factors that might lead to ethnic differences in NCI is a foundational step in developing targeted, culturally-relevant interventions to improve or minimize NCI, and thus reduce health disparities in this subpopulation. Among the many potential predictors of NCI, we focus on a set of potentially modifiable health behaviors that are particularly problematic among Hispanics, namely use of health services and personal practices associated with a healthy lifestyle (i.e., diet, and physical and cognitive activity). We also aim o examine some of the biomedical factors that might mediate the association of these health behaviors with NCI, including HIV disease burden and metabolic syndrome. Recognizing that Hispanics are a heterogeneous group, the research component of the present proposal focuses primarily on Hispanics of Mexican origin/descent, who are the largest Hispanic subgroup in the U.S. In support of the research proposal and the candidate's long-term goals, the comprehensive proposed training program builds on the applicant's background in clinical neuropsychology, as well as clinical research on cognitive aging and the neuropsychology of HIV, to gain key neuroAIDS knowledge (i.e. neuroAIDS disparities, and the intersection of HIV and aging), clinical research skills of particular relevance for cross-cultural studies (i.e. biostatistics, bioethics, and community engagement), as well as leadership and scientific communication skills. The multidisciplinary mentoring team includes expertise in all aspects of this proposal including neuroAIDS disparities (Primary Mentor: Dr. Robert Heaton; Co-mentor: Mara Luisa Zuniga; Consultant: Mariana Cherner; Collaborator: Dr. Mario de la Rosa); the intersection of aging and HIV (Co-Mentor: Dr. Dilip Jeste) including neuromedical implications (Consultant: Dr. Ronald Ellis); and cross-cultural psychometrics and biostatistics (Dr. Heaton and Consultants: Drs. Dan Mungas and Florin Vaida), bioethics (Dr. Zuniga), and community engagement (Dr. Zuniga). The present proposal will capitalize primarily on the University of California San Diego infrastructure, including the HIV Neurobehavioral Research Program, the Sam and Rose Stein Institute for Research on Aging, the Division of Global Public Health, and the Clinical and Translational Research Institute. It will also leverage expertise at the Universit of California Davis, and Florida International University. The excellent mentoring team and robust infrastructure will provide critical support to the applicant to successfully complete her training goals. This key training and new experience in executing the proposed research plan, along with her past clinical and research experiences and her Hispanic background will place her in a unique position to conduct highly impactful research that will serve the needs of a growing, underserved and vulnerable segment of the U.S. population.

 描述（由申请人提供）：神经认知障碍（NCI）在人类免疫缺陷病毒（HIV）感染中仍然非常普遍，并且使人衰弱，特别是在老年人中，西班牙裔是美国老年人口中增长最快的群体。在 HIV 感染病例中所占比例不成比例，而且他们在 HIV 感染者和老年人中的 NCI 风险均较高，但尚未对老年 HIV 感染者中的 NCI 进行检查。指导职业发展奖 (K23) 申请旨在培养申请人的技能，使其成为一名独立且精通文化的临床科学家，研究西班牙裔人群中与艾滋病毒感染和衰老相关的 NCI 发展的危险因素的作用。该申请包含一个有针对性的项目。研究项目旨在检查老年 HIV 感染者（主要是墨西哥裔/后裔）的 NCI 以及驱动与 HIV 和衰老相关的 NCI 种族差异的关键因素，阐明可能导致种族差异的心理社会和生物医学因素。 NCI 的研究是制定有针对性的、与文化相关的干预措施以改善或尽量减少 NCI 的基础步骤，从而减少该亚群的健康差异。在 NCI 的许多潜在预测因素中，我们重点关注一组特别是可能可改变的健康行为。我们还致力于研究一些可能介导这些健康行为与健康生活方式之间关系的生物医学因素。 NCI，包括艾滋病毒疾病负担和代谢综合征。认识到西班牙裔是一个异质群体，本提案的研究部分主要集中于墨西哥裔/后裔的西班牙裔，他们是美国最大的西班牙裔亚群体。和候选人的长期目标，综合拟定的培训计划建立在申请人的临床神经心理学背景以及认知衰老和艾滋病毒神经心理学的临床研究的基础上，以获得关键的神经艾滋病知识（即神经艾滋病差异、艾滋病毒与老龄化的交叉）、与跨文化研究特别相关的临床研究技能（即生物统计学、生物伦理学和社区参与），以及领导力和科学沟通技能。多学科指导团队包括。该提案各个方面的专业知识，包括神经艾滋病差异（主要导师：Robert Heaton 博士；共同导师：Mara Luisa Zuniga；顾问：Mariana Cherner；合作者：Dr. Mario de la Rosa）；衰老与艾滋病毒的交叉点（共同导师：Dilip Jeste 博士），包括神经医学影响（顾问：Ronald Ellis 博士）以及跨文化心理测量学和生物统计学（Heaton 博士和顾问：Drs. Dan Mungas 和 Florin Vaida）、生物伦理学（Zuniga 博士）和社区参与（Zuniga 博士） 目前的提案将主要利用加州大学圣地亚哥分校的基础设施，包括艾滋病毒。神经行为研究项目、萨姆和罗斯斯坦衰老研究所、全球公共卫生部门以及临床和转化研究所还将利用加州大学戴维斯分校和佛罗里达国际大学的专业知识。团队和强大的基础设施将为申请人成功完成其培训目标提供关键支持，这一关键培训和执行拟议研究计划的新经验，以及她过去的临床和研究经验以及她的西班牙裔背景将使她处于独特的地位。进行极具影响力的研究，以服务满足日益增长、服务不足和弱势群体的美国人口的需求。