Study of Aging Latinas/os for Understanding Dementia in HIV (SALUD HIV)

拉丁裔老龄化研究以了解艾滋病毒痴呆症 (SALUD HIV)

• 批准号: 10261346
• 负责人: MONICA G. RIVERA-MINDT
• 金额: $ 82.86万
• 依托单位: FORDHAM UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10261346
• 关键词: Acculturation; Address; Adult; Affect; African American; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Attention; Biological; Biological Factors; Biological Markers; Biological Models; Brain; Cardiovascular system; Chronic; Cognition; Cognitive; Cognitive aging; Country; Data; Dementia; Elderly; Equation; Ethnic Origin; Goals; HIV; HIV Infections; HIV-associated neurocognitive disorder; Health; High Prevalence; Hippocampus (Brain); Impaired cognition; Impairment; Infection; Inflammation; Interleukin-6; Intervention; Laboratories; Latin American; Latina; Lead; Learning; Lesion; Literature; Magnetic Resonance Imaging; Medial; Memory; Mexican Americans; Modeling; Morbidity - disease rate; Nerve Degeneration; Neuropathogenesis; Not Hispanic or Latino; Outcome; Participant; Pattern; Population; Public Health; Puerto Rican; Research; Risk; Risk Factors; Sampling; Scientist; Severities; Severity of illness; Stress; Structure; Temporal Lobe; Testing; Ursidae Family; Variant; Work; advanced dementia; age related; aged; aging population; base; brain health; cerebrovascular; cognitive change; cognitive function; comorbidity; cytokine; design; ethnic disparity; executive function; gray matter; health disparity; health equity; high risk; improved; indexing; lens; memory process; multidisciplinary; multimodality; neurocognitive disorder; neuroimaging; neuroinflammation; personalized approach; processing speed; relating to nervous system; social; social culture; virology; white matter

HIV remains a major public health problem, particularly for the Latina/o population. US-dwelling Latinas/os are at increased risk for HIV-infection compared to non-Hispanic whites and suffer a disproportionate burden of HIV-associated neurocognitive disorder (HAND) which may be amplified with age. HIV-infected (HIV+) Latinas/os of Puerto Rican origin have the highest prevalence of HAND (~78%) of any group in the US (HIV+ Mexican Americans: 44%; African Americans: ~40%, & non-Hispanic whites: ~40%). Older HIV+ Latinas/os (50± years) appear to be at even greater risk for HAND and cognitive decline than their non-Hispanic white counterparts, and the pattern of cognitive impairment in HAND appears to differ by ethnicity. In the general HIV population, HAND is characterized by impairments in processing speed, attention, and executive functioning consistent with involvement of the frontostriatal circuitry. HIV+ Puerto Rican Latinas/os present an atypical amnestic memory profile more consistent with medial temporal lobe (MTL) involvement. Despite these important disparities, differing cognitive profiles and possible differences in affected neural structures, the literature on HAND in Latinas/os is almost entirely cross-sectional, does not include HIV-uninfected (HIV-) controls, lacks studies focused on brain integrity in this population, and has yet to examine the mechanisms underlying these disparities. Utilizing a culturally-tailored approach, the goals of this study are to investigate whether older HIV+ Latinas/os of Puerto Rican origin demonstrate worse patterns of decline in cognitive function and brain integrity compared to other ethnic/HIV status groups, and to uncover the biological (e.g., neuroinflammatory biomarkers [sTREM2, sCD14, sTNFR-II, & IL-6], cardiovascular burden) and sociocultural (e.g., acculturation, social adversity, stress) mechanisms conferring risk for neurodegenerative and cognitive changes in this population. To that end, this multidisciplinary study will deploy a longitudinal observational design with 90 HIV+ and 90 HIV-matched control adults (both groups will include: 70% Latina/o and 30% non- Hispanic white; aged 60-80 yrs) over 36-months. All participants will complete laboratory, neuromedical, multimodal neuroimaging, and comprehensive cognitive and sociocultural assessments. Longitudinal structural equation models will test relationships between ethnicity, HIV, and biological and sociocultural factors on cognition (global, learning, memory, & processing speed) and MRI brain indices (white matter lesion & MTL gray matter volumes; MTL intrinsic activity, & hippocampal intra-network connectivity). Addressing disparities in cognitive and brain health outcomes in Latinas/os offers a vital opportunity to elucidate HAND neuropathogenesis, disentangle the biological and sociocultural aspects of cognitive aging through the lens of HIV-infection, and identify modifiable factors to mitigate risk for cognitive decline. As this population is the fastest-growing sector of the US aging population, identifying culturally-relevant intervention targets to lower age-related cognitive morbidity in Latinas/os is key for promoting brain health equity and public health.

艾滋病毒仍然是一个重大的公共卫生问题，尤其是对于拉丁裔/O人群。居住的拉丁裔/OS是 与非西班牙裔白人相比，HIV感染风险增加，遭受的伯宁 艾滋病毒相关的神经认知障碍（手）可能随着年龄的增长而扩大。 HIV感染（HIV+） 波多黎各起源的拉丁裔/OS的手（约78％）在美国（HIV+） 墨西哥裔美国人：44％；非裔美国人：〜40％和非西班牙裔白人：〜40％）。较旧的艾滋病毒+拉丁裔/OS （50±年）似乎比非西班牙裔白色更大的手和认知下降风险 同行和手头认知障碍的模式似乎因种族而有所不同。在一般艾滋病毒中 人口，手的特征是处理速度，注意力和执行功能的损害 与额叶电路的参与一致。 HIV+波多黎各拉丁裔/OS呈现非典型 柔软的内存曲线与媒体临时叶（MTL）的参与更加一致。尽管如此 重要的分布，不同的认知特征以及影响神经结构的可能差异， 拉丁裔/OS中手头的文献几乎完全是横截面，不包括HIV未感染（HIV-） 对照，缺乏研究该人群中大脑完整性的研究，尚未检查机制 这些分布的基础。利用文化定制的方法，本研究的目标是调查 年龄较大的艾滋病毒+拉丁裔/波多黎各人的起源是否表现出认知能力下降的模式较差 与其他种族/艾滋病毒状况组相比，功能和大脑完整性和大脑完整性和揭示生物学（例如， 神经炎性生物标志物[Streem2，SCD14，STNFR-II和IL-6]，心血管伯嫩）和社会文化 （例如，适应，社会广告，压力）机制会议的风险神经退行性和认知的风险 这个人群的变化。为此，这项多学科研究将部署纵向观察 具有90 HIV+和90名HIV匹配的对照成年人的设计（两组都包括：70％的Latina/O和30％的非 - 西班牙裔白色；超过36个月的60 - 80岁）。所有参与者将完成实验室，神经医学， 多模式神经影像学以及全面的认知和社会文化评估。纵向结构 方程模型将测试种族，艾滋病毒以及生物学和社会文化因素之间的关系 认知（全球，学习，记忆和处理速度）和MRI脑指数（白质病变和MTL 灰质卷； MTL内在活性和海马内网络连接）。解决分布 拉丁裔/OS的认知和大脑健康成果为阐明手提供了重要的机会 神经病发生，解散认知衰老的生物学和社会文化方面 HIV感染，并确定可修改的因素以减轻认知能力下降的风险。因为这个人口是 美国老年人口增长最快的部门，确定与文化相关的干预目标以降低 拉丁裔/OS中与年龄相关的认知发病率是促进大脑健康公平和公共卫生的关键。