Racial Disparities in Alzheimer's Disease and Related Dementias: The Role of Blood Pressure Throughout Adulthood

阿尔茨海默病和相关痴呆症的种族差异：血压在整个成年期的作用

• 批准号: 9164027
• 负责人: Elizabeth Rose Mayeda
• 金额: $ 12.63万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9164027
• 关键词: Accounting; Address; Adult; Affect; African; African American; Age; Age of Onset; Aging; Alzheimer' s Disease; Area; Award; Base of the Brain; Biology; Biometry; Blood Pressure; Brain; California; Cardiovascular Diseases; Clinical assessments; Cognitive; Complement; Data; Dementia; Development; Elderly; Epidemic; Epidemiologic Studies; Epidemiology; Exposure to; Goals; Grant; Health; High Prevalence; Hypertension; Impaired cognition; Incidence; Individual; Lead; Link; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical Records; Mentorship; Methods; Modeling; Neuropsychology; Outcome; Participant; Pathway interactions; Phase; Physical Examination; Population; Population Heterogeneity; Premature Mortality; Public Health; Records; Research; Research Training; Risk; Risk Factors; Role; Severities; Training; Universities; Vascular Diseases; brain health; career; checkup examination; clinical Diagnosis; cognitive change; cognitive function; cohort; disparity reduction; effective intervention; experience; health disparity; indexing; innovation; middle age; mortality; neuroimaging; neuropsychological; novel; prevent; racial and ethnic disparities; racial disparity; skills; vascular factor

PROJECT SUMMARY Alzheimer’s disease and related dementias are a major public health burden and disproportionately affect African Americans. The mechanisms underlying this disparity are not well-understood, but elevated blood pressure could be key. Compared with whites, African Americans have higher prevalence, earlier age of onset, and greater severity of hypertension. Thus, older African Americans tend to have greater cumulative exposure to elevated blood pressure throughout adulthood than older whites. No prior research, however, has quantified the contribution of hypertension to racial disparities in Alzheimer’s disease and related dementias. There are significant methodological challenges to addressing this important question, including (1) measurement of cumulative exposure to elevated blood pressure from the age of onset of hypertension through late adulthood, (2) measurement of cognitive function in diverse populations, and (3) possible survival bias, which is likely to differentially affect African Americans. The scientific objective of this research plan is to identify the extent to which elevated blood pressure from mid- through late- adulthood mediates racial disparities in Alzheimer’s disease and related dementias. This project uses an innovative approach to examine this important question with existing data from two diverse Northern California cohorts: the University of California, Davis Aging Diversity Cohort and the Kaiser Permanente Northern California Multiphasic Health Checkup cohort, which links mid-adulthood physical examinations with long-term medical record information. Analyses will address the three major methodologic challenges outlined above by examining cumulative exposure to elevated blood pressure as measured at multiple points in adulthood, developing a novel neuroimaging-based brain health index in a diverse population, and quantifying the potential magnitude of survival bias using comprehensive midlife data to account for differential survival. This research plan is complemented by a training plan that builds on the applicant’s background in epidemiology and biostatistics and includes new training in (1) measuring and modeling cognitive function in diverse populations, (2) clinical assessment and diagnosis of Alzheimer’s disease and related dementias, (3) assessing brain health with neuroimaging, and (4) the biology of vascular disease relevant to Alzheimer’s disease and related dementias. The combined research and training plans will prepare the applicant for a successful independent research career focused on identifying modifiable determinants of Alzheimer’s disease and related dementias in diverse populations. The methodological challenges addressed in this project are common to many areas of research on disparities in aging and cumulative exposure to risk factors throughout the lifecourse for Alzheimer’s disease and related dementias.

项目摘要 阿尔茨海默氏病和相关痴呆症是一种主要的公共卫生燃烧，不成比例地影响 非裔美国人。这种差异的基础机制不是很好理解，而是升高的血液 压力可能是关键。与白人相比，非裔美国人患病率更高，发病年龄较早， 和高血压的严重程度。那是年长的非裔美国人往往会有更大的累积暴露 整个成年期的血压升高，而不是较老的白人。但是，没有先前的研究已经量化 高血压对阿尔茨海默氏病和相关痴呆症中种族分布的贡献。有 解决这个重要问题的重大方法论挑战，包括（1）测量 累积暴露于高血压发作年龄至成年后的血压升高， （2）测量潜水员种群的认知功能，以及（3）可能的生存偏见，这很可能 对非裔美国人的影响有所不同。该研究计划的科学目标是确定 成年后期中期的血压升高了阿尔茨海默氏症的种族分布 疾病和相关痴呆症。该项目使用一种创新的方法来研究这个重要的问题 有来自两个潜水员北加州队列的现有数据：加利福尼亚大学戴维斯大学老化 多样性队列和Kaiser Permanente North California Multiphasic Health Checkup Cohort，它 将成本中期的身体检查与长期病历信息联系起来。分析将解决 上面概述的三个主要方法论挑战通过检查累积暴露于升高的血液 在成年期间以多个点测量的压力，发展了一种新型的基于神经影像学的大脑健康 潜水员人口中的索引，并使用综合 中年数据以说明差异生存。该研究计划是由培训计划完成的 建立在申请人的流行病学和生物统计学方面的基础上，包括（1）中的新培训 测量和建模潜水人群的认知功能，（2）临床评估和诊断 阿尔茨海默氏病和相关痴呆症，（3）通过神经影像评估大脑健康，以及（4）生物学 对阿尔茨海默氏病和相关痴呆症友好的血管疾病。联合研究和 培训计划将使申请人为成功的独立研究职业做好准备，专注于确定 阿尔茨海默氏病和相关痴呆症种群中的可修改决定者。 该项目中针对的方法论挑战对于分布的许多研究领域很常见 在整个生命过程中，老化和累积暴露于阿尔茨海默氏病及相关的风险因素 痴呆症。