SOCIAL FACTORS AND EPIDEMIOLOGY OF COGNITIVE DECLINE

描述（由申请人提供）：Shadlen博士的目标是成为痴呆症流行病学文献的主要贡献者。她的研究兴趣包括研究种族和社会参与对认知能力下降和痴呆症的影响。在获得K08奖项期间，她将在华盛顿大学提高自己的研究和培训技能。建议的课程包括：1)线性建模和生存分析课程；2)纵向研究设计经验；3)基金管理经验。埃里克·b·拉尔森博士将监督她的研究和培训。Itamar B. Abrass博士将提供老年医学专业知识和学术生涯指导。顾问包括博士。安妮特·菲茨帕特里克和大卫·西斯科维克。黑人的阿尔茨海默病发病率可能是白人的两倍。这种差异的原因没有得到很好的解释。最近的研究表明，生活方式的参与和痴呆症的临床表现之间存在关联。生活方式的参与是有目的的活动的表现，维持当前的健康状态或促进理想的未来。如果生活参与度低在黑人中更为普遍，那么这可能会增加患痴呆症的风险。这项拟议的工作将利用对3602名心血管健康研究（CHS）记忆项目参与者进行的为期6年的前瞻性观察。本研究提出的问题可能建议采取干预措施减少认知能力下降，从而延缓痴呆的进展。具体目的是：1)研究生活方式参与在预测认知衰退轨迹中的关联和效用；2)检查各种可操作性定义的生活方式参与领域，并比较其预测后续痴呆事件的能力；3)确定生活方式参与的分布模式及其与认知能力下降和痴呆发生率的关系是否存在种族差异；4)评估生活方式参与与生存的关系。指导临床科学家发展奖将使Shadlen博士能够1)获得先进流行病学技术方面的正式培训，2)分析国家、多中心、多民族的数据库，以及3)检验社会因素对神经退行性疾病流行病学有直接影响的模型。因此，这些项目将使Shadlen博士能够实现她的五年目标，将她对种族差异、痴呆症和流行病学的兴趣综合成一个独立的、发人深省的研究项目。

DESCRIPTION (provided by applicant): Dr Shadlen aims to become a leading contributor to the body of literature on dementia epidemiology. Her research interests include examining the influence of ethnicity and social engagement on cognitive decline and dementia. During the period of this K08 award, she will enhance her research and training skills at the University of Washington. The proposed program includes: 1) coursework in linear modeling and survival analysis, 2) experience in design of longitudinal studies, 3) experience in grant management. Dr. Eric B. Larson will oversee her research and training. Dr. Itamar B. Abrass will provide geriatric expertise and academic career guidance. Consultants include Drs. Annette Fitzpatrick, and David Siscovick. The incidence of AD may be two-fold higher among Blacks compared to Whites. Reasons for this discrepancy are not well explained. Recent studies suggest that there is an association between lifestyle engagement and clinical expression of dementia. Lifestyle engagement is the manifestation of purposeful activities that maintains a current state of well being or promotes a desirable future. If low lifestyle engagement is more common among Blacks, then, this may contribute to increased risk of developing dementia. The proposed work will capitalize on six years of prospective observation in an epidemiological cohort of 3602 Cardiovascular Health Study (CHS) Memory Project participants. Questions addressed in this study may suggest interventions to reduce cognitive decline, hence delaying the progression to dementia. The specific aims are: 1) To examine the associations and determine the utility of measures of Lifestyle Engagement in predicting the trajectory of cognitive decline; 2) To examine various operationally defined domains of lifestyle engagement and compare their abilities to predict subsequent incident dementia; 3) To determine whether there are ethnic differences in the pattern of distribution of lifestyle engagement and their associations with cognitive decline and incident dementia; and 4) To evaluate the association of Lifestyle Engagement and survival. The Mentored Clinical Scientist Development Award will enable Dr Shadlen to 1) obtain formal training in advanced epidemiological techniques, 2) analyze a national, multi-center, multiethnic database, and 3) test a model that social factors have direct effects on the epidemiology of neurodegenerative disease. Hence, these projects will allow Dr Shadlen to achieve her 5-year goal of synthesis of her interests in racial differences, dementia, and epidemiology into an independent, thought-provoking research program.