Mechanisms of Cognitive Decline Across Socioeconomic and Clinical Contexts

社会经济和临床背景下认知衰退的机制

• 批准号: 10120416
• 负责人: JARROD DALTON
• 金额: $ 40.25万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10120416
• 关键词: African American; Age; Aged, 80 and over; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Antihypertensive Agents; Behavioral; Cardiovascular Diseases; Cardiovascular system; Caring; Censuses; Characteristics; Climate; Clinical; Clinical Data; Cognition Disorders; Cognitive; Communities; Complex; Data; Data Science; Diagnosis; Dimensions; Disease Outcome; Effectiveness; Elderly; Electronic Health Record; Equation; Ethnic Origin; Event; Exercise; Funding; Geriatrics; Health; Health Food; Health Services Accessibility; Health Services Research; Health and Retirement Study; Hematology; Hypertension; Impaired cognition; Incidence; Individual; Inequality; Intervention; Lead; Learning; Life Cycle Stages; Life Expectancy; Location; Measures; Mediating; Methods; Modeling; Nature; Neighborhoods; Neurology; Obesity; Ohio; Onset of illness; Outcome; Patients; Performance; Persons; Physical environment; Population; Population Heterogeneity; Positioning Attribute; Prevalence; Preventive care; Race; Registries; Research; Risk; Risk Factors; Science; Shapes; Social Environment; Socioeconomic Status; Stress; Study models; System; Testing; Time; Variant; Weather; Work; atherosclerosis risk; base; cardiovascular risk factor; career; caucasian American; cognitive function; cohort; contextual factors; data resource; early onset; ethnic minority population; improved; innovation; insight; low socioeconomic status; member; modifiable risk; patient population; predictive modeling; prevent; primary care services; profiles in patients; racial minority; residence; socioeconomics

PROJECT SUMMARY/ABSTRACT Inequality in health outcomes in relation to Americans’ socioeconomic position (SEP) is rising, despite recent evidence that the life expectancy gap between black and white Americans may be decreasing1. The disparity in life expectancy (given survival to age 50) between individuals in the top and bottom deciles of career earnings has nearly doubled over the last 20 years.2 Emerging research has indicated that these inequalities are also observed in studies of cognitive decline, with racial and ethnic minorities and persons of low socioeconomic status demonstrating earlier onset or more rapid cognitive decline in multiple studies. An analysis of the Health and Retirement Study has further found that neighborhood socioeconomic position (SEP) and cardiovascular risk factors increase the odds of poor cognitive function among older adults. Our current NIA-funded study, “Modeling and Forecasting Atherosclerotic Risk: A Complex Systems Approach” (R01AG055480) is utilizing electronic health record (EHR) data in a first-of-its-kind regional, population-derived registry to understand how neighborhood social contexts influence cardiovascular risk across the life course. The NEOCARE Learning Health Registry includes data collected from 1999 to 2019 on more than 3.1 million unique individuals, diverse by race and ethnicity in Northeast Ohio. In this supplement we will implement a multifaceted, systems-based approach for jointly modeling risk of cognitive and cardiovascular disorders. Our work will evaluate the influence of neighborhood conditions on incidence and prevalence of Alzheimer’s and related dementias. We will also describe the relationship between hypertension and cognitive function across the socioeconomic spectrum, with a special focus on the mediating influence of antihypertensive therapies. Lastly, we aim to investigate and compare the influence of immuno-hematologic function, obesity and cardiovascular disease and SEP on cognitive function. The results of our study are expected to improve the effectiveness and delivery of primary care services by (i) promoting a deeper understanding about how short and long-term contextual factors involving patients’ social and physical environments lead to variation in Alzheimer’s disease onset and outcomes; and (ii) identifying and quantifying the importance of modifiable risk factors across heterogeneous populations that can be used to develop population-specific interventions to prevent or delay the onset of Alzheimer’s and dementia. This research is anticipated to yield new mechanistic insights, hypotheses for testing in future research applications, more accurate and representative models for predicting Alzheimer’s disease and dementia, and a basis for informing decisions at multiple strategic and programmatic levels.

项目概要/摘要 尽管最近，与美国人的社会经济地位（SEP）相关的健康结果的不平等正在加剧 有证据表明美国黑人和白人之间的预期寿命差距可能正在缩小1。 职业生涯最高十分位和最低十分位个人之间的预期寿命（假设存活到 50 岁） 过去 20 年里，收入几乎翻了一番。2 新兴研究表明，这些不平等现象 在认知能力下降的研究中也观察到了这一现象，其中包括少数种族和族裔以及低​​收入人群 多项研究表明社会经济状况显示其发病较早或认知能力下降较快。 对健康与退休研究的分析进一步发现，社会经济邻里地位 (SEP) 和心血管危险因素会增加老年人认知功能不良的可能性。 我们目前由 NIA 资助的研究“动脉粥样硬化风险建模和预测：复杂系统方法” (R01AG055480) 正在利用电子健康记录 (EHR) 数据进行首个基于人口的区域性研究 登记以了解邻里社会环境如何影响整个生命过程中的心血管风险。 NEOCARE 学习健康登记处包含 1999 年至 2019 年收集的超过 310 万个数据 在俄亥俄州东北部，不同种族和民族的独特个人将在本增刊中实施。 多方面的、基于系统的方法，用于联合建模认知和心血管疾病的风险。 这项工作将评估社区条件对阿尔茨海默病发病率和患病率的影响， 我们还将描述高血压与认知功能之间的关系。 社会经济范围，特别关注抗高血压治疗的中介影响。 最后，我们的目的是调查和比较免疫血液功能、肥胖和 心血管疾病和 SEP 对认知功能的影响我们的研究结果有望改善。 通过 (i) 促进更深入地了解初级保健服务的有效性和提供 涉及患者社会和物理环境的长期背景因素会导致变化 阿尔茨海默病的发病和结果；以及 (ii) 识别和量化可改变风险的重要性 跨异质人群的因素，可用于制定针对人群的干预措施 预防或延缓阿尔茨海默氏症和痴呆症的发病，预计这项研究将产生新的机制。 见解、在未来研究应用中测试的假设、更准确和更具代表性的模型 预测阿尔茨海默病和痴呆症，并为多个战略和决策提供依据 程序化级别。

项目成果

Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population.

• DOI: 10.1016/j.ijcha.2020.100624
• 发表时间: 2020-12
• 期刊: International journal of cardiology. Heart & vasculature
• 作者: May AM;Wang L;Kwon DH;Van Wagoner DR;Chung MK;Dalton JE;Mehra R
• 通讯作者: Mehra R

Health Status and Chronic Disease Burden of the Homeless Population: An Analysis of Two Decades of Multi-Institutional Electronic Medical Records.

• DOI: 10.1353/hpu.2021.0153
• 发表时间: 2021
• 期刊: Journal of health care for the poor and underserved
• 影响因子: 1.4
• 作者: Bensken WP;Krieger NI;Berg KA;Einstadter D;Dalton JE;Perzynski AT
• 通讯作者: Perzynski AT

Evaluating and Modeling Neighborhood Diversity and Health Using Electronic Health Records.

• DOI: 10.1177/0272989x221123569
• 发表时间: 2022-11
• 期刊: MEDICAL DECISION MAKING
• 影响因子: 3.6
• 作者: Dalton, Jarrod E.;Pfoh, Elizabeth R.;Dawson, Neal, V;Mourany, Lyla;Becerril, Alissa;Gunzler, Douglas D.;Berg, Kristen A.;Einstadter, Douglas;Krieger, Nikolas, I;Perzynski, Adam T.
• 通讯作者: Perzynski, Adam T.

Relationship of Neighborhood Deprivation and Outcomes of a Comprehensive ST-Segment-Elevation Myocardial Infarction Protocol.

• DOI: 10.1161/jaha.121.024540
• 发表时间: 2021-12-21
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Huded, Chetan P.;Dalton, Jarrod E.;Kumar, Anirudh;Krieger, Nikolas I.;Kassis, Nicholas;Phelan, Michael;Kravitz, Kathleen;Reed, Grant W.;Krishnaswamy, Amar;Kapadia, Samir R.;Khot, Umesh
• 通讯作者: Khot, Umesh

Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research.

• DOI: 10.1177/0272989x20954403
• 发表时间: 2021-03
• 期刊: Medical decision making : an international journal of the Society for Medical Decision Making
• 作者: Taksler GB;Dalton JE;Perzynski AT;Rothberg MB;Milinovich A;Krieger NI;Dawson NV;Roach MJ;Lewis MD;Einstadter D
• 通讯作者: Einstadter D