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.

项目摘要 非洲裔美国人（AAS）的发生率不成比例，并且更早的阿尔茨海默氏病和 相关痴呆症（ADRD）相对于白人美国人。虽然先前的研究已经大大 我们对ADRD中种族分布的理解的贡献，我们仍然缺乏对 个人如何成为AA的生活经验，包括累积的结构性种族主义，有助于 提高了ADRD风险以及这些风险的潜在机制。建立在现有的基础上， 我们团队以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 居住在两个历史上被剥夺的，主要是AA社区的居民队列（n = 1133） 整个生命的动态社区社会经济状况如何促进认知结果 中后期成年人。该提案基于邻里种族隔离和随后的前提 投资投资会导致AAS的认知结果不良，包括a）较低的访问权限 教育机会和b）更高的接触种族和社会经济与与社会经济相关的压力源，包括 歧视，创伤和不利的童年事件。反过来，这些累积暴露促进了心理 居民的警惕，导致心脏代谢失调和睡眠中断，这可能会导致 邻里灾难与ADRD风险之间的关联。我们还将检查潜在的保护 可能促进认知健康的因素，包括社区社会凝聚力，安全性和满意度。 拟议的研究将利用我们现有关于风险和受保护因素的纵向数据，生物行为 介体和基线认知评估，并将包括：1）三波认知评估波 全部50岁以上的参与者队列（35-49岁的参与者将有两个 评估）和50岁以上参与者的ADRD的临床调整（n = 906），2）额外 评估血压和客观睡眠，3）对生活和居民的全面评估 使用健康与退休研究（HRS）的问卷调查的历史； 4）深入的定性 采访以揭示AAS在实现最佳认知方面经历的生命机会和障碍 晚年的健康。了解结构性种族主义如何影响AA的现场经验，包括 随着时间的流逝，邻里条件的动态变化对于告知多层干预和政策至关重要 减少ADRD中普遍存在的种族和社会经济差异的努力。