Cerebrovascular Disease and Cognitive Performance in African Americans

描述（由申请人提供）：在世界范围内，脑血管病（CBVD）及其相关认知障碍的发病率正在迅速上升。非裔美国人（AA）和糖尿病患者CBVD和相关认知功能障碍的发生率较高。然而，通过脑磁共振成像（MRI）和认知测试评估的种族对CBVD发展的影响研究仍然很少。相对于欧洲裔美国人（EA），关于AA脑小血管疾病的严重程度存在争议。小血管疾病在脑MRI上表现为“白质高信号”（WMH）。一些研究报告称，相对于EA， AA群体的WMH更高，而一些群体的WMH更低。现有的研究未能解释影响WMH发展的潜在可改变的环境风险因素的影响，如获得医疗保健、社会经济地位、血压和血糖控制。该应用旨在确定600例AA型2型糖尿病患者大脑结构和功能变化背后的环境和遗传因素。我们计划通过脑MRI和一系列认知测试重新评估正在进行的AA-糖尿病心脏研究（AA- dhs）中的600名AA；这些人之前都接受过隐性（亚临床）心脏病的检测，并且都有可用于基因检测的DNA。我们计划在这些AA受试者中测试脑结构（包括WMH）和脑功能改变与认知表现之间的关系。为了确定CBVD和认知表现之间的关系是否存在种族差异，将AA患者的结果与相关糖尿病心脏研究（DHS-MIND）中患有T2D的EA患者的类似数据进行对比。本研究将尝试检测影响AA患者CBVD易感性的遗传和环境因素。我们期望可改变的环境风险因素可以解释现有研究中报道的高CBVD发生率。此外，注意这些可改变的危险因素可能会降低高危AA人群中CBVD和认知功能障碍的发生率。

DESCRIPTION (provided by applicant): The incidence rates of cerebral vascular disease (CBVD) and its associated cognitive impairment are rapidly increasing around the world. African Americans (AA) and patients with diabetes have higher rates of CBVD and associated cognitive dysfunction. However, the impact of race on the development of CBVD assessed by Magnetic Resonance Imaging (MRI) of the brain and cognitive testing remains poorly studied. Controversy exists regarding the severity of cerebral small blood vessel disease in AA, relative to European Americans (EA). Small blood vessel disease appears as "white mater hyperintensities" (WMH) on brain MRI. Several studies have reported more WMH, and some less WMH, in AA relative to EA. Existing studies failed to account for the effects of potentially modifiable environmental risk factors that impact development of WMH, such as access to healthcare, socioeconomic status, blood pressure and blood sugar control. This application proposes to determine the environmental and genetic factors that underlie cerebral structural and functional changes in 600 AA with type 2 diabetes. We plan to re-evaluate 600 AA in the ongoing AA-Diabetes Heart Study (AA-DHS) with cerebral MRI and a battery of cognitive tests; these individuals have previously been tested for the presence of silent (sub-clinical) heart disease and all have DNA available for genetic testing. We plan to test for relationships between alterations in brain structure (including WMH) and brain function with cognitive performance in these AA subjects. To determine whether racial differences in the relationships between CBVD and cognitive performance are present, results in AA would be contrasted with similar data in EA who have T2D from the related Diabetes Heart Study (DHS-MIND). This proposal will attempt to detect the inherited and environmental factors that produce susceptibility to CBVD in AA. We expect that modifiable environmental risk factors may explain the higher rates of CBVD reported in existing studies of AA. Furthermore, attention to these modifiable risk factors may reduce the rates of CBVD and cognitive dysfunction in the high risk AA population.