IKE Kapuna (Elder Wisdom) Project

研究项目2：摘要 据预测，夏威夷的阿尔茨海默病和相关痴呆症（ADRD）的患病率正在上升。 到2025年，10%的65岁以上的人将被诊断为ADRD。全国范围内，夏威夷土著和太平洋 岛民（NHPIs）比白人，亚洲人和非洲裔美国人更有可能早发ADRD。NHPI 高血压、肥胖、糖尿病和血脂异常的患病率高于美国其他种族和民族 这增加了ADRD的可能性。ADRD通常在主观认知障碍之前， 轻度认知障碍，这为早期干预提供了机会，以预防或延迟ADRD的发作。 促进身体活动、健康饮食以及社会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量身定制舞蹈课程 没有一个国家将国家保健机构包括在内。我们完成了一项随机对照研究， 在277名患有不受控制的高血压的NHPIs中进行了一项以Hula为特色的干预试验。6个月后， 干预降低了收缩压（-5.4 mmHg，p = 0.02）和舒张压（-4.4 mmHg，p = 0.01） 与对照组相比。因此，我们将与夏威夷的5个社区组织合作， 调整我们现有的草裙舞干预措施，并测试其改善血管健康和维持或 改善ADRD高危NHPI老年人的认知功能。IKE Kupuna（长者智慧）项目将 使用定性的方法来修改我们现有的12个月的草裙舞课程， 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 一项随机分组试验，纳入208名年龄在50-75岁之间的NHPI，其中至少有4种可改变的血管风险因素之一， ADRD（高血压、高血糖、肥胖或血脂异常）和SCI或MCI（使用等待列表对照） 设计主要结局将是ADRD的血管风险因素和主观认知主诉。 次要结局将包括认知表现、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与 基因型、血管危险因素和认知功能。我们的具体目标是：1）适应我们的 现有的基于Hula的干预措施，以针对痴呆的血管风险因素，改善认知症状，或 功能，并优化具有主观认知障碍的NHPI的突出性，实施和坚持 或轻度认知障碍; 2）进行一组随机试验，以测试“IKE Kupuna”对血管的影响。 12个月内ADRD和认知主诉和功能的风险因素;和3）评估横断面 血管危险因素和APOE基因型与认知障碍和功能的关系NHPI长者 人口在不断增加，他们的需求也在不断升级。这将是第一项测试新干预措施的研究， 解决NHPIs中的ADRD，并评估该组中APOE-ε4基因型与认知功能的关联。

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.