The Epidemiology of Alzheimer's Disease and Related Dementias in Sexual and Gender Minority Older Adults: Identifying Risk and Protective Factors

摘要 到2030年，将有近600万性少数和性别少数(SGM)60岁及以上的老年人 认为自己是女同性恋、男同性恋、双性恋和变性人的美国人。约350,000名SGM老年人在 美国目前有阿尔茨海默氏症和相关痴呆症(ADRD)，预测接近1 到2030年将达到100万。然而，对SGM老年人中ADRD的患病率或风险几乎一无所知 没有艾滋病毒/艾滋病。这项提案将侧重于SGM老年人中ADRD的流行病学和风险。第一 这项建议的目的是在以人群为基础的样本中描述ADRD的流行病学和风险 并将SGM老年人ADRD的患病率和发病率与他们的 异性恋同龄人。第二个目标将集中于确定老年SGM患者ADRD的风险和保护因素 并估计患抑郁症的人群归因风险和社会经济地位(例如收入 和教育)在ADRD上。第三个目标将涉及以社区为基础的样本的主要数据收集 SGM老年人为了调查风险和保护因素与认知之间的关系， 包括记忆和执行功能。这项提议包含了几项创新，将使我能够 评估SGM老年人认知障碍和ADRD的流行病学和风险：1)这将是 儿童认知功能障碍和ADRD的流行病学及相关危险因素和保护因素研究 SGM老年人；2)它利用了全国最大的纵向数据集，基因研究计划 环境与健康(RPGEH)，包括关于SGM老年人身体和心理社会健康的数据；以及 3)它涉及一项可能与记忆和执行功能相关的因素的新调查 SGM老年人的损害。为了顺利完成这项研究，我提出了三个培训目标：1) ADRD风险和保护因素的高级统计模型；2)SGM衰老和健康的流行病学 差异；3)认知老化的测量和分析。这个职业发展奖最终将 结果提交了R01，以开发未来认知老化的多点流行病学研究和 老年人SGM中的ADRD。鉴于目前对这一人群中的ADRD风险一无所知，这项工作 有必要促进早期发现；制定与文化相关的筛查和有针对性的预防措施 降低SGM老年人ADRD风险的干预措施；并改善老年人的护理和生活质量 脆弱和未得到充分研究的人群。

Abstract By 2030, there will be nearly six million sexual and gender minority (SGM) older adults aged 60 and older in the U.S. who identify as lesbian, gay, bisexual and transgender. Approximately 350,000 SGM older adults in the U.S. currently have Alzheimer’s disease and related dementias (ADRD), with projections nearing one million by 2030. Yet, almost nothing is known about the prevalence or risk of ADRD in SGM older adults without HIV/AIDS. This proposal will focus on the epidemiology and risk of ADRD in SGM older adults. The first aim of this proposal is to characterize the epidemiology and risk of ADRD in a population-based sample of SGM older adults and compare the prevalence and incidence of ADRD in SGM older adults to their heterosexual peers. The second aim will focus on identifying risk and protective factors for ADRD in SGM older adults, and to estimate the population attributable risk of depression and socioeconomic status (e.g., income and education) on ADRD. The third aim will involve primary data collection in a community-based sample of SGM older adults in order to investigate the relationship between risk and protective factors and cognition, including memory and executive function. This proposal incorporates several innovations that will allow me to evaluate the epidemiology and risk of cognitive impairment and ADRD in SGM older adults: 1) this will be the first study of the epidemiology and associated risk and protective factors for cognitive impairment and ADRD in SGM older adults; 2) it leverages the largest longitudinal dataset in the nation, Research Program for Genes Environment and Health (RPGEH), with data on the physical and psychosocial health of SGM older adults; and 3) it involves a novel investigation of factors that may be associated with memory and executive function impairment in SGM older adults. To successfully complete this research, I propose three training aims: 1) advanced statistical modeling of ADRD risk and protective factors; 2) epidemiology of SGM aging and health disparities; and 3) measurement and analysis of cognitive aging. This career development award ultimately will result in the submission of a R01 to develop a future multi-site epidemiological study of cognitive aging and ADRD in SGM older adults. Given that nothing is currently known about ADRD risk in this population, this work is necessary to promote early detection; to develop culturally relevant screenings and targeted preventative interventions to decrease ADRD risk in SGM older adults; and to improve the care and quality of life of this vulnerable and understudied population.