The Contribution of Repetitive Head Impacts and Social Determinants of Health to Alzheimer's Disease and Related Dementia in Older Adult Black Men

重复性头部撞击和健康的社会决定因素对老年黑人阿尔茨海默病和相关痴呆症的影响

• 批准号: 10740485
• 负责人: Robert W. Turner
• 金额: $ 129.35万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740485
• 关键词: Accelerometer; Adult; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Amyloid beta-Protein; Atrophic; Biological Assay; Biological Markers; Black American; Black Populations; Black race; Blood; Boston; Brain; Cerebrospinal Fluid; Childhood; Cognition; Cognitive; Collaborations; Data; Data Set; Detection; Diagnosis; Diffusion; Disease; Disparity; Dose; Economics; Education; Elderly; Enrollment; Environment; Equation; Exposure to; Face; Frequencies; Goals; Health; Hippocampus; Impaired cognition; Individual; Late Effects; Life; Light; Link; Magnetic Resonance Imaging; Manufactured football; Mediating; Modeling; Neighborhoods; Nerve Degeneration; Neurobehavioral Manifestations; Neurodegenerative Disorders; Neurologic; Neurological outcome; Outcome; Participant; Pathway interactions; PhenX Toolkit; Plasma; Play; Positioning Attribute; Poverty; Proteins; Publishing; Questionnaires; Research; Resistance; Risk; Risk Factors; Role; Severities; Surveys; Tauopathies; Testing; Traumatic Brain Injury; Underrepresented Populations; Universities; Washington; Wellness Program; White Matter Hyperintensity; adverse childhood events; black men; brain health; chronic traumatic encephalopathy; cognitive function; contact sports; dosage; education access; experience; head impact; health care availability; health care quality; indexing; instrument; men; nervous system disorder; neurofilament; neuropsychiatric symptom; neuropsychiatry; racial disparity; racial identity; recruit; resilience; response; social factors; social health determinants; tau-1; white matter

ABSTRACT. Black Americans face nearly double the risk of Alzheimer’s disease (AD) and related compared to Whites. Black American men may be at increased risk for late-life neurological disorders associated with exposure to repetitive head impacts (RHI) and traumatic brain injury (TBI) from contact sports participation and other risk factors. Exposure to RHI/TBI is linked with late-life cognitive impairment, neuropsychiatric disturbances, and structural brain changes. Black racial identity and exposure to RHI/TBI has been shown to have an additive effect on MRI metrics of atrophy and cerebrospinal fluid neurodegenerative disease proteins. These neurological disparities might be explained by social determinants of health (SDOH) (e.g., education access and quality, health care access and quality, neighborhood environment), which might affect resistance and resilience to other neurological disorders from RHI/TBI. SDOH factors might indeed contribute to neurological outcomes in adult Black men irrespective of RHI/TBI. Yet, there has been persistent under- representation of Blacks in biomedical and health research, including among studies of the late effects of RHI from American football play. The overarching goal of this study is to examine the impact of RHI/TBI from American football and the contribution of early-life SDOH to later-life cognitive function, neuropsychiatric symptoms, structural MRI features, and plasma biomarkers in Black male former American football athletes and non-RHI/TBI exposed Black men. We will recruit 100 Black male former American football athletes (across all levels of play and cognitive continuum, 50+ years) and 100 age-matched Black males without RHI/TBI. Participants will enroll to complete harmonized cognitive and neuropsychiatric tests, MRI, and blood draw to assess neurodegenerative disease proteins. A battery of questionnaires (e.g., Adverse Childhood Experiences, Childhood-Experiences Survey, SHARELIFE survey) will be administered to assess SDOH. In Aim 1, we will investigate the association between RHI/TBI and later-life cognitive and neuropsychiatric symptoms in Black male former American football athletes. Aim 2 will investigate the association between RHI/TBI and later-life biomarkers of Aß, p-tau, and neurodegeneration outcomes in Black male former American football athletes. Aim 3 will examine the contribution of SDOH to later-life cognitive and neuropsychiatric symptoms and later-life biomarkers of Aß, p-tau, and neurodegeneration outcomes. Our hypotheses are that (1) RHI/TBI will be associated with worse cognitive and neuropsychiatric function and compromised structural gray/white matter in Black former football players; (2) impoverished SDOH will increase risk and reduce resilience to the late-life effects of RHI/TBI; and (3) impoverished SDOH will mediate the effects of RHI on late-life neurological outcomes. This R01 will discover the role of RHI/TBI and SDOH in older Black men. We will address racial disparities present in data on late life neurological outcomes from RHI/TBI to facilitate accurate disease detection and diagnosis at the individual-level.

摘要：美国黑人患阿尔茨海默病 (AD) 及相关疾病的风险几乎增加了一倍。 与白人相比，美国黑人男性晚年患神经系统疾病的风险可能更高。 因参加接触性运动而遭受重复性头部撞击 (RHI) 和创伤性脑损伤 (TBI) 暴露于 RHI/TBI 与晚年认知障碍、神经精神障碍有关。 事实证明，黑人种族认同和接触 RHI/TBI 会导致大脑结构变化。 对萎缩和脑脊液神经退行性疾病蛋白的 MRI 指标有累加效应。 这些神经系统差异可能可以通过健康的社会决定因素（SDOH）来解释（例如，教育 获取和质量、医疗保健获取和质量、邻里环境），这可能会影响抵抗力 RHI/TBI 因素对其他神经系统疾病的恢复能力确实可能有助于改善。 成年黑人男性的神经系统结果与 RHI/TBI 无关，但一直存在不足。 黑人在生物医学和健康研究中的代表性，包括后期影响的研究 本研究的首要目标是研究 RHI/TBI 的影响。 从美式足球到早年 SDOH 对晚年认知功能、神经精神学的贡献 黑人男性前美国橄榄球运动员和运动员的症状、结构 MRI 特征和血浆生物标志物 我们将招募 100 名非 RHI/TBI 暴露的黑人男性前美国橄榄球运动员（涵盖所有黑人）。 游戏和认知连续体水平（50 岁以上）和 100 名年龄匹配的没有 RHI/TBI 的黑人男性。 参与者将报名完成统一的认知和神经精神测试、MRI 和抽血，以 评估神经退行性疾病蛋白质的一系列调查问卷（例如，不良童年经历， 将进行童年经历调查、SHARELIFE 调查来评估 SDOH。在目标 1 中，我们将进行评估。 研究黑人 RHI/TBI 与晚年认知和神经精神症状之间的关联 目标 2 将调查 RHI/TBI 与晚年生活之间的关联。 黑人男性前美国橄榄球运动员 Aß、p-tau 和神经变性结果的生物标志物 Aim。 3 将检查 SDOH 对晚年认知和神经精神症状以及晚年生活的贡献 Aß、p-tau 和神经变性结果的生物标志物是 (1) RHI/TBI。 与较差的认知和神经精神功能以及灰质/白质结构受损有关 黑人前足球运动员；(2) 贫困的 SDOH 会增加风险并降低晚年的恢复力 RHI/TBI 的影响；(3) 贫困的 SDOH 将介导 RHI 对晚年神经系统结果的影响。 本 R01 将发现 RHI/TBI 和 SDOH 在老年黑人中的作用，我们将解决种族差异问题。 存在于 RHI/TBI 的晚年神经学结果数据中，以促进准确的疾病检测和 个人层面的诊断。