IKE Kapuna (Elder Wisdom) Project

研究项目2：摘要 据预测，夏威夷阿尔茨海默病和相关痴呆症(ADRD)的患病率正在上升 到2025年，65岁以上的人中将有10%被诊断出患有ADRD。全国、夏威夷原住民和太平洋地区 岛民(NHPI)比白人、亚洲人和非裔美国人更有可能患有早发性ADRD。NHPI指数 与美国其他种族和民族相比，高血压、肥胖、糖尿病和血脂异常的患病率更高 这增加了ADRD的可能性。ADRD之前通常有主观认知障碍和 轻度认知障碍，这为早期干预提供了机会，以预防或推迟ADRD的发病。 促进体力活动、健康饮食以及社交和认知活动的干预措施可以预防或减缓 认知能力下降。值得注意的是，跳舞可以保持或改善认知功能和神经成像参数， 同时减少血管风险因素。然而，很少有研究为ADRD量身定做舞蹈节目 对种族或族裔少数群体的预防，没有一项包括卫生和社会保险。我们完成了一项随机对照 以呼啦圈为特征的干预措施对277例无节制高血压患者的干预试验在6个月的时间里， 干预降低了收缩压(-5.4 mm Hg，p=0.02)和舒张压(-4.4 mm Hg，p=0.01) 与对照条件进行比较。因此，我们将与夏威夷的5个社区组织合作，以 调整我们现有的呼啦圈干预措施并测试其在改善血管健康和维持或 改善NHPI高危ADRD老年人的认知功能。艾克·库普纳(长者智慧)项目将 用定性的方法修改我们现有的12个月的Hula高血压课程，并了解文化 饮食教育、认知练习和社会参与策略。然后我们将进行一次务实的 对208名50-75岁的NHPI进行的分组随机试验，其中至少有4个可修改的血管危险因素中的一个 ADRD(高血压、高血糖、肥胖或血脂异常)和使用等待名单对照的SCI或MCI 设计。主要结果将是ADRD的血管危险因素和主观认知主诉。 次要结果将包括对认知表现、身体功能和心理健康的测量。我们 还将收集所有参与者的生物标本，以评估APOE之间的横截面关联 基因、血管危险因素、认知主诉和功能。我们的具体目标是：1)调整我们的 现有的基于草裙草裙的干预措施针对痴呆的血管危险因素，改善认知症状或 功能，并优化主观性认知障碍NHPI的显着性、实施和依从性 或轻度认知障碍；2)进行一组随机试验，以测试艾克苦参素对血管的影响 ADRD的危险因素和12个月以上的认知症状和功能；以及3)评估横断面 血管危险因素和载脂蛋白E基因与认知症状和功能的关系。NHPI长辈 人口在增加，他们的需求也在不断升级。这将是第一个测试一种新的干预措施的研究 在NHPI中解决ADRD问题，并评估APOE-ε4基因与本组认知功能的关联。

RESEARCH PROJECT 2: ABSTRACT The prevalence of Alzheimer’s disease and related dementias (ADRD) is rising in Hawai`i, where it is projected that 10% of people aged 65+ will be diagnosed with ADRD by 2025. Nationwide, Native Hawaiians and Pacific Islanders (NHPIs) are more likely to have early-onset ADRD than Whites, Asians, and African Americans. NHPIs have a higher prevalence of hypertension, obesity, diabetes, and dyslipidemia than other US racial and ethnic groups, which increase the likelihood of ADRD. ADRD is often preceded by subjective cognitive impairment and mild cognitive impairment, which offers an opportunity for early intervention to prevent or delay ADRD onset. Interventions that promote physical activity, healthy diet, and social and cognitive activities can prevent or slow cognitive decline. Notably, dancing can preserve or improve cognitive functioning and neuroimaging parameters, while reducing vascular risk factors. However, very few studies have tailored a dance program for ADRD prevention for racial or ethnic minorities, and none have included NHPIs. We completed a randomized controlled trial of an intervention featuring Hula in 277 NHPIs with uncontrolled hypertension. Over 6 months, the intervention lowered systolic (-5.4 mmHg, p = 0.02) and diastolic (-4.4 mmHg, p = 0.01) blood pressure compared to the control condition. We therefore will partner with 5 community-based organizations in Hawai‘i to adapt our existing Hula intervention and test its effectiveness for improving vascular health and maintaining or improving cognitive function in NHPI elders at high risk of ADRD. The ‘IKE Kupuna (Elder Wisdom) Project will use qualitative methods to revise our existing 12-month Hula curriculum for hypertension with culturally informed dietary education, cognitive exercises, and social engagement strategies. We will then conduct a pragmatic group-randomized trial with 208 NHPIs aged 50-75 years with at least 1 of 4 modifiable vascular risk factors for ADRD (hypertension, hyperglycemia, obesity, or dyslipidemia) and either SCI or MCI using a wait-list control design. The primary outcomes will be vascular risk factors for ADRD and subjective cognitive complaints. Secondary outcomes will include measures of cognitive performance, physical function, and mental health. We will also collect biospecimens from all participants to evaluate the cross-sectional association between APOE genotype, vascular risk factors, and cognitive complaints and function. Our Specific Aims are to: 1) Adapt our existing Hula-based intervention to target vascular risk factors for dementia, improve cognitive symptoms or function, and optimize salience, implementation, and adherence in NHPIs with subjective cognitive impairment or mild cognitive impairment; 2) Conduct a group randomized trial to test the effect of ‘IKE Kupuna on vascular risk factors for ADRD and cognitive complaints and function over 12 months; and 3) Evaluate the cross-sectional association of vascular risk factors and APOE genotype with cognitive complaints and function. The NHPI elder population is increasing and their needs are escalating. This will be the first study to test a novel intervention to address ADRD in NHPIs and to assess the association APOE-ε4 genotype with cognitive function in this group.