EXPLAINING DISPARITIES IN COGNITIVE FUNCTION IN SENIORS

描述(摘自调查人员摘要) 认知功能是日常功能和生活质量的核心。 众所周知，慢性阻塞性肺疾病的生命轨迹因种族/民族而异， 社会经济地位(SES)，这种变化涉及一个复杂的因果网络。 拆解这一因果网络具有重要的政治、社会和公共健康 影响，并为预防和确保社会 公平。然而，我们对这些因素只有一个初步的了解 调和这些差异在CF中。因果关系网是复杂的，涉及到 不同的可能相互关联的领域，如遗传、社会、行为 环境、背景因素和个人血管健康。直接式 而这些不同因素的间接贡献必须在 试图解释种族/民族和SES的差异，超越了 “基因-环境”的传统探索，但有一定的局限性 通过更广泛地定义这些差异的基础，“相互作用”。 老年人CF值下降的普遍潜在原因包括铅 暴露、载脂蛋白E(ApoE)基因、血管危险因素(如血液 压力)，以及危害健康的行为(例如，不活动和吸烟)。 重要的是，一些已知的因种族/民族而不同的基因似乎 影响铅的毒代动力学或毒性，包括对 8-氨基酮丙酸脱水酶(ALAD)、维生素D受体(VDR)、Na/K-ATP酶 (NKATP)和载脂蛋白E基因。必须使用以下方法检查CF中的差异 允许对因果关系进行建模的下一代数据和方法 这些多个领域的结构，以及如何以及在多大程度上社交， 行为因素和背景因素是重要的中介和调节因素 沿着一条延伸的因果路径。只有通过测试这个更完整的模型， 是否有可能完整地解释复杂的多层次关联 这就是日常生活的模式。这项研究的目标是了解 铅吸收的直接和间接影响，四个特定基因， 个人社会和行为因素、背景因素和血液 种族/民族和社会经济状况与慢性阻塞性肺疾病相关性的解释压力 和认知能力下降。调查人员提出了一个为期五年的预期 随机抽取900名50~70岁城市居民进行研究 种族/民族和社会经济地位不同的特定地理区域。所有研究 受试者将每隔16个月访问三次，测量 认知功能、血压、胫骨导联、膝导联、个体 社会和行为因素，当前和过去的背景因素，以及ALAD， VDR、NKATP和ApoE基因分型。

DESCRIPTION (Taken from the Investigator's Abstract) Cognitive function (CF) is central to daily functioning and quality of life. The life course trajectory in CF is known to vary by race/ethnicity and socioeconomic status (SES), and this variation involves a complex causal web. Unpacking this causal web has important political, social, and public health implications, and provides a foundation for prevention and for ensuring social equity. However, we have only a rudimentary understanding of the factors that mediate these disparities in CF. The causal web is complex and involves such diverse and possibly interrelated domains as genetic, social, behavioral, environmental, contextual factors, and individual vascular health. The direct and indirect contributions of these diverse factors must be considered in trying to explain variation by race/ethnicity and SES, moving beyond the traditional but somewhat limiting exploration of "gene-environment interactions" by more broadly defining the underpinnings of these disparities. Ubiquitous potential causes of a decline in CF in older adults include lead exposure, apolipoprotein E (ApoE) genotype, vascular risk factors (i.e., blood pressure), and health-compromising behaviors (e.g., inactivity and smoking). Importantly, a number of genes known to differ by race/ethnicity appear to influence the toxicokinetics or toxicity of lead, including those for the 8-aminolevulinic dehydratase (ALAD), vitamin D receptor (VDR), Na/K ATPase (NKATP), and ApoE genes. Disparities in CF must be examined using next-generation data and methods that allow the modeling of the causal structure of these multiple domains, and to see how and to what extent social, behavioral, and contextual factors are important mediators and moderators along an extended causal pathway. Only by testing this more complete model, will it be possible to fully explicate the complex multilevel associations that pattern everyday life. The goal of this research is to understand the direct and indirect influences of lead absorption, four specific genes, individual social and behavioral factors, contextual factors, and blood pressure in accounting for the associations of race/ethnicity and SES with CF and cognitive decline. The investigators propose a five-year prospective study of 900 urban residents, aged 50 to 70 years, randomly selected from specific geographic areas with variation in race/ethnicity and SES. All study subjects will have three visits at 16-month intervals, with measurement of cognitive function, blood pressure, tibial lead, patellar lead, individual social and behavioral factors, current and past contextual factors, and ALAD, VDR, NKATP, and ApoE genotypes.