Longitudinal Examination of Neighborhood Disadvantage, Cognitive Aging, and Alzheimer's Disease Risk in Disinvested, African American Neighborhoods

对投资撤资的非裔美国人社区的社区劣势、认知老化和阿尔茨海默病风险进行纵向调查

• 批准号: 10565869
• 负责人: Tamara Dubowitz
• 金额: $ 200.08万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10565869
• 关键词: Adult; African American; African American population; Age Distribution; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Blood Pressure; Clinical; Cognitive; Cognitive aging; Cohort Studies; Communities; Data; Development; Diabetes Mellitus; Diagnosis; Disadvantaged; Discrimination; Disparity; Early Onset Alzheimer Disease; Early identification; Economic Conditions; Education; Elderly; Enrollment; Exposure to; Fostering; Funding; Health; Health and Retirement Study; Heterogeneity; Household; Housing; Impaired cognition; Individual; Inequity; Intervention; Interview; Investments; Life; Life Cycle Stages; Longitudinal Studies; Longitudinal cohort; Low income; Measures; Mediating; Mediator; Methods; Natural experiment; Neighborhoods; Outcome; Participant; Pattern; Policies; Poverty; Prevention; Questionnaires; Race; Recording of previous events; Research; Research Infrastructure; Rest; Risk; Risk Factors; Role; Safety; Sampling; Science; Sleep; Sleep disturbances; Structural Racism; Time; Trauma; Urban Renewal; Variant; adjudication; adverse childhood events; aged; biobehavior; cardiometabolic risk; cardiometabolism; caucasian American; cognitive change; cognitive function; cognitive testing; cohort; community based research; dementia risk; design; experience; land use; marginalization; middle age; neighborhood disadvantage; protective factors; psychologic; racial disparity; racial health disparity; resilience factor; response; satisfaction; segregation; social; social cohesion; sociodemographics; socioeconomic disparity; socioeconomics; stressor; vigilance

Project Summary African Americans (AAs) have disproportionately higher rates and earlier onset of Alzheimer’s disease and related dementias (ADRD) relative to White Americans. Although prior research has made significant contributions to our understanding of racial disparities in ADRD, we still lack a comprehensive understanding of how the individual lived experience of being AA, including cumulative exposure to structural racism, contributes to elevated ADRD risk and the potential mechanisms underlying those risks. Building on the existing, community-based research infrastructure developed by our team’s previously funded studies, we will follow a cohort of residents (n=1133) living in two historically disinvested, predominantly AA communities to understand how dynamic neighborhood socioeconomic conditions across the lifecourse contribute to cognitive outcomes in mid- and late-life adults. This proposal rests on the premise that neighborhood segregation and subsequent disinvestment contributes to poor cognitive outcomes for AAs via factors including a) lower access to educational opportunities and b) higher exposure to race- and socioeconomically-relevant stressors, including discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. We also will examine potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk and protective factors, biobehavioral mediators, and baseline cognitive assessments, and will include: 1) three waves of cognitive assessments in the full cohort of participants who are 50 years+ (participants who are aged 35-49 years will have two assessments) and clinical adjudication of ADRD in participants who are 50+ (n=906), 2) additional assessments of blood pressure and objective sleep, 3) a comprehensive assessment of life and residential history using the questionnaire from the Health and Retirement Study (HRS); and 4) in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by AAs in achieving optimal cognitive health in late life. Understanding how structural racism has influenced the lived experience of AAs including dynamic changes in neighborhood conditions over time is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.

项目概要 非裔美国人 (AA) 的阿尔茨海默病发病率较高且发病较早， 尽管先前的研究已经取得了显着的成果，但与美国白人相关的痴呆症（ADRD）相关。 虽然我们对 ADRD 中种族差异的理解有所贡献，但我们仍然缺乏全面的了解 作为 AA 的个人生活经历，包括累积的结构性种族主义暴露，如何有助于 ADRD 风险升高以及这些风险背后的潜在机制。 由我们团队之前资助的研究开发的基于社区的研究基础设施，我们将遵循 居住在两个历史上投资不足、主要是 AA 社区的居民群体 (n=1133) 了解 整个生命周期中动态的邻里条件如何影响认知结果 该提案的前提是邻里隔离和随后的生活。 投资减少会导致 AA 的认知结果不佳，其原因包括：a) 获取资源的机会较少 教育机会 b) 更高程度地接触种族和社会相关的压力源，包括 歧视、创伤和不良童年事件反过来又会促进心理。 居民保持警惕，导致心脏代谢失调和睡眠中断，这可能会介导 我们还将研究邻里劣势与 ADRD 风险之间的关联。 可能促进认知健康的因素，包括邻里社会凝聚力、安全性和满意度。 拟议的研究将利用我们现有的关于风险和保护因素、生物行为的纵向数据 中介和基线认知评估，将包括：1）三波认知评估 50 岁以上的全部参与者（35-49 岁的参与者将有两个 评估）和 50 岁以上参与者 (n=906) 的 ADRD 临床判定，2) 额外 血压和客观睡眠的评估，3）生活和居住的综合评估 使用健康与退休研究 (HRS) 问卷调查历史；4) 深入定性； 访谈揭示 AA 在实现最佳认知过程中所经历的生命历程机遇和障碍 了解结构性种族主义如何影响 AA 的生活经历，包括 邻里条件随时间的动态变化对于为多层次干预和政策提供信息至关重要 减少 ADRD 中普遍存在的种族和社会经济差异。