Lifecourse Pathways to Racial Disparities in Late-Life Cognitive Impairment

描述（由申请人提供）：认知障碍和痴呆方面的种族差异已经成为一个严重的公共卫生问题。研究人员使用具有全国代表性的数据估计，在71岁及以上的人群中，黑人患痴呆症的可能性大约是白人的两倍。黑人患轻度认知障碍的风险也是白人的四倍。到2030年，65岁及以上的黑人人数将增加一倍以上，从2000年的280万增加到2030年的720万，因此，老年黑人中认知障碍和痴呆症的流行将在未来几年恶化。尽管近年来对认知障碍和痴呆相关危险因素的了解有所进展，但很少有基于人群的研究调查认知障碍中种族差异的起源、机制和后果。该研究将仔细界定认知障碍差距的大小，与差距相关的近端和远端因素，以及差距对老年黑人和白人无认知障碍预期寿命的影响。数据来自健康和退休研究（HRS），这是一项正在进行的具有全国代表性的纵向调查，调查对象是51岁及以上的美国人，以及老龄化、人口统计和记忆研究（ADAMS）。ADAMS是HRS的一部分，因为对70岁及以上的HRS受访者进行了临床评估，并被诊断为痴呆、认知障碍但不是痴呆（CIND）或正常认知。具体来说，我们的目标是1)分别检验HRS认知功能指标作为黑人和白人认知障碍和痴呆筛查工具的敏感性和特异性；2)研究与认知障碍种族差异相关的生命历程路径；3)根据性别和童年条件估计有和没有认知障碍的黑人和白人的预期寿命。分析将以1998-2008年的HRS为基础。认知障碍的患病率和发病率模型将对70岁及以上的人进行估计。本研究结果将促进我们对认知障碍中种族差异的起源、机制和后果的理解，并有助于政策制定者和公共卫生专业人员设计有效的干预措施，以减少认知障碍中的种族差异，并为认知障碍患者制定相关的医疗保健和长期护理需求计划。

DESCRIPTION (provided by applicant): The racial gap in cognitive impairment and dementia has emerged as a serious public health problem. Researchers using nationally representative data estimated that among those aged 71 years and older Blacks were approximately two times more likely to have dementia than Whites. Blacks also had four times greater risk of having mild cognitive impairment than Whites. The epidemic of cognitive impairment and dementia among older Blacks will worsen in future years as the number of Blacks aged 65 and over will more than double by 2030, increasing from 2.8 million in 2000 to 7.2 million by 2030. Despite developments in understanding the risk factors associated with cognitive impairment and dementia in recent years, very few population-based studies have investigated the origins, mechanisms, and consequences of the racial gap in cognitive impairment. The proposed investigation will carefully define the magnitude of the gap in cognitive impairment, the proximal and distal factors associated with the gap, and the consequences of the gap for cognitive-impairment-free life expectancy for older Blacks and Whites. Data come from the Health and Retirement Study (HRS), an ongoing nationally representative, longitudinal survey of Americans 51 years of age and older and Aging, Demographics, and Memory Study (ADAMS). ADAMS is part of the HRS in that a subset of HRS respondents aged 70 years and older were clinically assessed and assigned a diagnosis of dementia, cognitive impairment but not demented (CIND), or normal cognition. Specifically, we aim to 1) examine the sensitivity and specificity of the HRS cognitive functioning measures as a screening tool for cognitive impairment and dementia for Blacks and Whites respectively; 2) examine life course pathways associated with the racial gap in cognitive impairment; 3) estimate life expectancy with and without cognitive impairment for Blacks and Whites by gender and childhood conditions. The analysis will be based on the 1998-2008 waves of HRS. Models of both prevalence and incidence of cognitive impairment will be estimated for persons aged 70 years and older. The findings from this research will advance our understandings of the origins, mechanisms, and consequences of racial gaps in cognitive impairment and can help policy makers and public health professionals design effective interventions to reduce racial disparities in cognitive impairment and make plans for the associated health care and long-term care needs of those suffering from cognitive impairment. PUBLIC HEALTH RELEVANCE: The primary goal of the project is to examine the origins, mechanisms, and consequences of racial gaps in cognitive impairment. Results from this project could potentially help policy makers and public health professionals design effective interventions to reduce racial disparities in cognitive health and make plans for the associated health care and long-term care needs for older Blacks and Whites suffering from cognitive impairment.