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

项目摘要 这一行政补充的主要目标是收集必要的数据， 数据分析，以扩大对生命早期遭受武装冲突的了解， 影响阿尔茨海默病和相关痴呆症（ADRD）的风险。的重点 行政补充是创建用于测量ADRD和分析ADRD风险的数据 越南健康与老龄化研究（VHAS）的子样本中的因素， 对居住在美国四个地区的2，447名美国战争幸存者进行了纵向研究。 越南北方。研究团队将通过认知表现测试评估ADRD 老年痴呆症社区筛查工具（CSI-D）， 在中低收入背景下得到广泛验证。CSI-D涉及认知和 测试的受访者和线人采访一个亲密的家庭成员，将受到 VHAS设置中的验证。除了CSI-D之外，使用预定用于 在第二波VHAS期间收集，项目补充将收集和分析 同型半胱氨酸和改编自O 'Bryant的ADRD的基于血液的生物标志物诊断面板 母研究资助了2018年收集的Wave I数据和Wave II收集 计划于2021年进行，提供了关于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发现了严重的心理疾病， 战争压力源;由于广泛喷洒橙子剂和其他 越南各地的化学脱叶剂;以及儿童时期的不良环境经历， 青年期，包括严重的粮食短缺和社区一级的轰炸暴露。 拟议补编的工作范围是建立关于营养的补充数据， 摄入，以获得ADRD生物标志物同型半胱氨酸和10种分析物ADRD的测定 生物标志物面板，并进行分析，探索战争相关的压力，因为他们影响 认知功能和ADRD风险。武装冲突在发展中国家最为普遍， 像越南这样的国家，人口进入老年， 经验丰富的战争正在迅速增长，但我们几乎没有长期的知识 战争暴露对ADRD的影响。这项研究将注意力转向战争，因为它可能有助于 或减损健康的老龄化，特别是神经退行性疾病，如ADRD， 给中低收入国家的医疗保健和养老机构带来沉重负担。 为了实现我们的行政补充研究目标，我们将：a）创建和实施一个 补充调查模块，检查由CSI-D评估的ADRD VHAS的450名成员的子集，根据随机配额抽样方法选择 这为评估不同战争压力水平的ADRD提供了重要的统计能力 暴露; B）使用全血进行同型半胱氨酸和ADRD生物标志物组的测定 在VHAS的Wave II中创建的样本; c）并入CSI-D、ADRD生物标志物组，以及 将同型半胱氨酸测量纳入更大的VHAS数据集; d）对战时和 冲突后面临的风险，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和橙子剂暴露，以及目前的ADRD经历。 VHAS国际项目组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 ADRD风险的经验。我们将采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广泛传播到 公共卫生、老年学和 在相关领域，为受战争影响的人口提供有针对性的预防、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.