The contribution of adult child socio-economic status to parents' risk and outcomes of Alzheimer's disease and related dementias (ADRDs) in cross-national settings

在全球范围内，近1000万老年人被诊断患有阿尔茨海默病和相关痴呆症（ADRD） 每年.鉴于目前缺乏有效的药物治疗方法，加上全球在药物治疗方面的差异，沿着 痴呆症护理，迫切需要确定ADRD预防和干预的人群水平目标， 包括在家庭和社会层面。大部分人群水平的ADRD研究集中在 一个人的社会经济地位（SES）对晚年ADRD风险的贡献。然而，在许多全球 在这种背景下，成年子女的社会经济地位可能是父母经济、信息和行为的关键驱动力。 晚年的资源然而，很少有研究评估成年子女SES对父母的影响。 ADRD的风险或ADRD的结局。这是一个令人惊讶的被忽视的机会，因为先前的文献表明， 成年子女的教育程度可能影响父母的身心健康和死亡率， 独立于父母自身的教育。这项研究的目的是严格 评估成年儿童SES降低父母ADRD风险和改善结局的潜力， 在全球范围内，患有ADRD的老年父母。我们还将评估一套全面的 经济和非经济途径，可能是观察到的关联的基础，并确定亚组 老年人可能从改善子女的教育中受益最多。我们建议 使用来自北美和中美洲20个国家的156，000多名成年人的人口水平队列数据， 亚洲和欧洲，以及类似的成年儿童教育措施和关于候选调解人的丰富数据， 多级修饰符。这些全球数据将使我们能够实现出色的外部有效性，而这是单- 我们将使用严格的观察方法来分析主要效应和中介作用。 为了最大限度地提高内部有效性，我们将采用准实验方法验证观察估计， 利用义务教育法的变化作为“自然实验”，以确定 增加成人子女教育对父母纵向认知结果的影响。我们聚集了一个 我们是一个跨学科团队，在这些全球老龄化队列数据方面拥有深厚的专业知识， 流行病学和计量经济学方法，对认知老化进行人口层面的研究， 具体目的：1）量化成年子女SES对老年父母认知能力下降的影响， 痴呆或认知障碍，以及痴呆发作后老年父母的结局，2）评估经济状况 以及观察到的成年儿童SES和父母ADRD风险之间关联的非经济中介， 结果，以及3）确定成年儿童SES与 父母的ADRD风险和结果。我们的研究利用了国家20多年的投资， 老龄化研究所在全球老龄化队列研究中评估了关于影响 对父母ADRD风险和结果的影响。

Globally, nearly 10 million older adults are diagnosed with Alzheimer’s disease and related dementias (ADRDs) each year. Given the current absence of effective pharmacological treatments, along with global disparities in dementia care, there is an urgent need to identify population-level targets of ADRDs prevention and intervention, including at the family and societal level. Much of the population-level ADRDs research focuses on the contributions of one’s own socio-economic status (SES) to later life ADRDs risk. However, in many global settings, the SES of adult children may be a critical driver of parents’ economic, informational, and behavioral resources in late life. Nevertheless, very little research has evaluated the impact of adult child SES on parents’ ADRDs risk or outcomes of ADRDs. This is a surprisingly overlooked opportunity given prior literature suggesting that adult child educational attainment may influence parents’ physical and mental health and mortality outcomes, independent of parents’ own education. The objective of this proposed study is to rigorously evaluate the potential for adult child SES to reduce parental ADRDs risk and improve outcomes among older parents with ADRDs in global settings. We will additionally evaluate a comprehensive set of economic and non-economic pathways that may underlie observed associations and identify subgroups of older adults who may benefit most from improvements to their children’s education. We propose to use population-level cohort data on over 156,000 adults representing 20 countries in North and Central America, Asia, and Europe, and with similar measures of adult child education and rich data on candidate mediators and multi-level modifiers. These global data will allow us to achieve excellent external validity not possible with single- country studies, and we will use rigorous observational approaches for analyses of main effects and mediation. To maximize internal validity, we will validate observational estimates with a quasi-experimental approach that leverages changes to compulsory schooling laws as “natural experiments” to identify the causal effect of increases to adult child education on parents’ longitudinal cognitive outcomes. We have gathered an interdisciplinary team with deep expertise in these global aging cohort data and the application of rigorous epidemiologic and econometric methods to population-level research on cognitive aging to carry out the following Specific Aims: 1) Quantify the influence of adult child SES on older parents’ cognitive decline, risk of probable dementia or cognitive impairment, and outcomes for older parents after dementia onset, 2) Evaluate economic and non-economic mediators of observed associations between adult child SES and parents’ ADRDs risk and outcomes, and 3) Identify within and cross-country heterogeneity in the association between adult child SES and parents’ ADRD risk and outcomes. Our study makes use of the over 20 years of investment of the National Institute on Aging in global aging cohort studies to evaluate largely unanswered questions regarding the influence of adult child SES on parents’ ADRDs risk and outcomes.