Early Life War Experiences and Alzheimer’s Disease and Related Dementias

项目总结 本行政副刊的主要目标是收集必要的数据和进行 数据分析，以扩大对早年接触武装冲突的了解，因为 影响阿尔茨海默病和相关痴呆(ADRD)的风险。这次会议的重点是 行政补充是创建用于衡量ADRD和分析ADRD风险的数据 正在进行的越南健康和老龄化研究(VHAS)的子样本中的因素 对居住在四个地区的2447名美国战争老年幸存者的纵向研究 越南北部。研究小组将通过认知表现测试来评估ADRD 痴呆症社区筛查仪(CSI-D)，已被 在中低收入人群中得到广泛验证。CSI-D，它涉及到认知 将对被调查者进行测试，并对举报人与近亲家庭成员进行面谈 到VHAS设置中的验证。除了CSI-D，还使用了预定用于 收集在第二波VHAS期间，项目补充将收集和化验 同型半胱氨酸和O‘Bryant改编的ADRD血液生物标志物诊断小组 等人的研究。母研究，为2018年收集的第一波数据和第二波收集提供资金 计划于2021年发布，提供有关ADRD各种风险因素的详细、纵向数据， 在其他主要是西方人群中也被发现，即严重的心理 战争应激源；因广泛喷洒橙剂和其他药物而暴露于二恶英 越南各地的化学落叶剂；儿童时期和 青壮年，包括严重的食物短缺和社区一级的爆炸暴露。 拟议补编的工作范围是创建关于营养方面的额外数据 摄入量，以获得ADRD生物标志物同型半胱氨酸和10-分析物ADRD的分析 生物标记物小组，并进行分析，探索与战争有关的应激源及其影响 认知功能与ADRD风险。武装冲突在发展中最为普遍 像越南这样的国家，那里的人口既进入老年，又直接 经历过的战争正在迅速增长，但我们几乎不知道其中的长期 战争暴露对ADRD的影响。这项研究将注意力引向战争，因为它可能有助于 或损害健康的衰老，特别是像ADRD这样的神经退行性疾病 中低收入国家的医疗保健和护理机构负担沉重。 为了实现我们的行政补充研究目标，我们将：a)创建和实施 补充调查模块，用于检查CSI-D在 根据随机配额抽样方法选择的450个VHAS成员的子集 这为评估不同战争压力水平的ADRD提供了显著的统计力量 暴露；b)使用全血进行同型半胱氨酸和ADRD生物标志物小组的分析 在VHAS第二波中创建的样本；c)结合CSI-D、ADRD生物标志物小组，以及 同型半胱氨酸测量到更大的VHAS数据集；d)进行战时和 冲突后暴露，即粮食不安全/缺乏、极端心理压力和 相关的创伤后应激障碍，橙剂暴露，以及ADRD的当前经验。 VHAS国际项目团队将利用收集的数据来检查动态 战争暴露、压力环境、社会关系和老年人之间的联系 对ADRD风险的经验。我们将使用纵向分析技术来解决 关于战争暴露的持久影响的问题，包括关于机制的问题 战争通过它影响认知功能。结果将在以下方面广泛传播 公共卫生、老年学和公共卫生领域的学者、政策制定者和从业人员的社区 为受战争影响的民众量身定做预防、护理和支助。

PROJECT SUMMARY The primary goal of this administrative supplement is to collect necessary data and conduct data analysis in order to expand understanding of early life exposures to armed conflict as they influence risks for Alzheimer’s disease and related dementias (ADRD). The focus of the administrative supplement is the creation of data for measuring ADRD and analyzing ADRD risk factors among a subsample of the Vietnam Health and Aging Study (VHAS), an ongoing longitudinal study of 2,447 older adult survivors of the American War residing in four districts of northern Vietnam. The study team will assess ADRD through a cognitive performance test instrument, the Community Screening Instrument for Dementia (CSI-D), which has been validated widely in low-middle income contexts. The CSI-D, which involves both cognitive testing for the respondent and an informant interview with a close family member, will be subject to validation in the VHAS setting. In addition to the CSI-D, using whole blood samples slated for collection during the second wave of VHAS, the project supplement will collect and assay homocysteine and a blood-based biomarker diagnostic panel for ADRD adapted from O’Bryant et al. The parent study, which funds Wave I data collected in 2018 and Wave II collection scheduled for 2021, provides detailed, longitudinal data on myriad risk factors for ADRD that have been identified in other, largely western populations, namely severe psychological stressors of war; dioxin exposure due to widespread spraying of Agent Orange and other chemical defoliants across Vietnam; and experience of adverse conditions during childhood and young adulthood, including severe food shortage and community-level bombing exposure. The scope of work within the proposed supplement is to create additional data on nutritional intake, to obtain assays of the ADRD biomarker homocysteine and a 10-analyte ADRD biomarker panel, and to perform analyses which explore war-related stressors as they influence cognitive functioning and ADRD risk. Armed conflict has been most pervasive in developing countries like Vietnam, where the population both moving into old age and having directly experienced war is growing rapidly, but where we have virtually no knowledge of the long-term effects of war exposure on ADRD. This study directs attention toward war as it may contribute to or detract from healthy aging, especially neurodegenerative diseases like ADRD which impose heavy burdens upon healthcare and caregiving institutions in low-middle income countries. To meet our administrative supplement study goals, we will: a) create and implement a supplementary survey module which examines ADRD as assessed by the CSI-D within a subset of 450 members of the VHAS, selected according to a random quota sampling method that yields significant statistical power for assessing ADRD across levels of war stress exposure; b) perform assays of homocysteine and a ADRD biomarker panel using whole blood samples created in Wave II of VHAS; c) incorporate the CSI-D, ADRD biomarker panel, and homocysteine measures into the larger VHAS dataset; d) conduct analyses of wartime and post-conflict exposures, namely food insecurity/deficiency, extreme psychological stress and related PTSD, and agent orange exposure, and current experience of ADRD. The VHAS international project team will utilize the assembled data to examine dynamic linkages between war exposure, stress environments, social relations, and older adult experience of ADRD risk. We will employ longitudinal analytical techniques to address questions about war exposure’s enduring effects, including questions about the mechanisms through which war influences cognitive functioning. Results will be disseminated widely across communities of scholars, policy-makers, and practitioners in public health, gerontology and allied fields, to tailor prevention, care and support in war-affected populations.