Early Vascular Contributions to Dementia Risk in African-Americans

非洲裔美国人的痴呆症和阿尔茨海默氏症的发病率比非西班牙裔高出40%-100% 白人和非裔美国人(AA)--美国老年人口中增长最快的群体之一-- --如果趋势持续下去，将构成痴呆症“银色海啸”中最大的一部分。理解 老年再障患者的认知老化是一个迫切的公共卫生需求。虽然认知功能减退和痴呆 对于年长的AA个人来说是主要的健康问题，这是一个不同的群体，了解如何 暴露和健康在生活过程中的差异影响晚年认知的变异性对 制定干预措施并了解如何降低风险。基于人群的认知队列研究 再生障碍性贫血中的衰老很少，特别是那些遵循认知衰老轨迹的人 生活。AA有更高的中风、糖尿病和高血压的发病率，阿尔茨海默病的既定危险因素， 并且有更广泛的不良生活经历，这可能会影响晚年的认知健康。2013年 美国国立卫生研究院关于预防认知衰退的科学状况建议采用生命周期方法，包括 早期的生命暴露与晚年的大脑老化。然而，尽管阿尔茨海默氏症的易感性增加， 血管疾病使再生障碍性贫血成为识别生命过程暴露的关键群体，这是早期所知的大多数 阿尔茨海默病和认知老化的生活风险和保护因素主要来自人群 对非西班牙裔白人的研究。我们提出了一项关于大脑老化的生命过程研究，该研究将利用50年的 前瞻性收集生活史和健康数据。我们的目标是：1)在纵向上表现出异质性 在具有良好特征的非洲人的代表性人群队列中领域特定认知的变化 美国人，2)。检查累积暴露于血管风险、心理社会因素和早期生活经历 超过50岁，并评估对认知老化的影响，以及3)。脑结构磁共振成像标志物的评价 领域特异性认知功能的状态与脑状态之间的关系探讨 生命过程因素和认知。这些发现将直接造福于阿尔茨海默氏症高危人群 疾病和痴呆症在美国，一直没有从生命过程的角度进行研究，而且是 预计到2030年，美国65岁以上人口的规模将增加一倍以上。

Rates of dementia and Alzheimer’s disease are 40-100% higher in African-Americans versus non-Hispanic whites, and African-Americans (AA) – one of the fastest-growing segments of the elderly population in the US - - will comprise the largest segment of the ‘silver tsunami’ of dementia if trends persist. Understanding cognitive aging in elderly AA represents an urgent public health need. Though cognitive decline and dementia are major health issues for older AA individuals, this is a heterogeneous group and understanding how differences in exposures and health over the lifecourse influence variability in latelife cognition is critical for developing interventions and understanding how to reduce risk. Population-based cohort studies of cognitive ageing in AA are few, specifically those which follow trajectories of cognitive aging in the 5th and 6th decade of life. AA have higher rates of stroke, diabetes and hypertension, established risk factors for Alzheimer’s disease, and have broader exposure to adverse life experience which may impact late-life cognitive health. The 2013 NIH State of the Science on Preventing Cognitive Decline recommended a lifecourse approach, incorporating early life exposures with brain aging in late life. Yet, while increased vulnerability to Alzheimer’s disease and vascular disease make AA a crucial group to identify lifecourse exposures, most of what is known about early life risk and protective factors of Alzheimer’s disease and cognitive aging is largely from populations based studies of non-Hispanic whites. We propose a lifecourse study of brain aging that will utilize 5 decades of prospectively collected life history and health data. Our goals are: 1).Characterize heterogeneity in longitudinal change in domain specific cognition in a representative population based cohort of well characterized African- Americans, 2). Examine cumulative exposure to vascular risk, psychosocial factors and early life experience over 50 years and evaluate effects on cognitive aging, and 3). Evaluate structural MRI imaging markers of brain status on domain-specific cognitive function and explore brain status as mediators of the association between lifecourse factors and cognition. Findings will directly benefit a population that is at highest risk of Alzheimer’s disease and dementia in the United States, has been understudied from a lifecourse perspective, and is expected to more than double in size by 2030 within the age 65+ segment of the US population.