Resilience Mechanisms Underlying Racial/Ethnic Disparities in Alzheimer’s Disease

这项纵向研究的总体目标是确定新的、可改变的种族/民族差异机制， 阿尔茨海默病（AD）在一个多种族队列中的约2,000名老年人。的发生率 与非西班牙裔白人相比，非裔美国人和西班牙裔美国人的AD更高，即使在控制了 差异研究中的“常见嫌疑人”：传统社会经济指标和血管健康。 持续的和无法解释的差异表明了两种尚未得到充分研究的可能性：（1）已知的 AD风险因素在人种/种族间表现出不同的影响和/或（2）尚未测量的因素会增加AD 少数民族的风险。我们的研究团队已经确定了多个因素，这些因素对认知影响更大， 老年非裔美国人或西班牙裔美国人，包括抑郁症状和脑部病理的MRI标记。 这些变量，沿着血管健康状况差和教育/收入较低，可能对 白人，因为在一个多数群体中的成员资格与社会环境资源有关， 促进复原力。在目前的提案中，复原力被概念化为好于预期的成果 考虑到AD风险因素或脑病理学的水平。这项研究将探讨如何不同的资源， 我们的组群中的种族/民族（例如，感知的社会地位，教育质量，以及生活的感知， 结果是可控的）在AD致病途径中的多个点使用重复 三个时间点的MRI和认知评估。因为种族/族裔少数群体面临独特的 应激源（例如，文化适应压力，种族歧视），我们还将测试这些经验是否 影响脑病理学、认知能力下降和AD事件的MRI标志物的进展。我们 总体假设是，由于少数种族/民族耗尽了资源，AD差异持续存在 以适应已知的AD风险因素和脑病理学和/或独特的，但未测量的AD风险因素。具体 目的是（1）确定与少数民族人口有关的风险因素，并检查它们是否预测 在非裔美国人或西班牙裔美国人中推进大脑病理学、认知能力下降和AD事件，（2） 确定哪些资源可以解释已知AD风险因素对 推进脑病理学（即，大脑弹性），以及（3）确定哪些资源解释种族/民族 进展性脑病理对认知下降和AD事件的影响的差异（即，认知 弹性）。

The overall aim of this longitudinal study is to identify new, modifiable mechanisms of racial/ethnic disparities in Alzheimer's disease (AD) among a multi-ethnic cohort of approximately 2,000 older adults. The incidence of AD is higher for African Americans and Hispanics, compared to non-Hispanic Whites, even after controlling for the “usual suspects” in disparities research: traditional socioeconomic indicators and vascular health. Persistent and unexplained disparities suggest two possibilities that have not been well-examined: (1) known AD risk factors exhibit differential impact across race/ethnicity and/or (2) yet unmeasured factors increase AD risk for minorities. Our research team has identified multiple factors that have stronger cognitive impact among older African Americans or Hispanics, including depressive symptoms and MRI markers of brain pathology. These variables, along with poor vascular health and lower education/income, may be less impactful among Whites because membership in a majority group is associated with social-environmental resources that promote resilience. In the current proposal, resilience is conceptualized as better-than-expected outcomes given level of AD risk factors or brain pathology. This study will examine how resources that differ across race/ethnicity in our cohort (e.g., perceived social status, quality of education, and the perception that life outcomes are controllable) promote resilience at multiple points in the AD pathogenic pathway using repeat MRI and cognitive assessments across three time points. Because racial/ethnic minorities face unique stressors (e.g., acculturative stress, racial discrimination), we will also test whether these experiences influence the progression of MRI markers of brain pathology, cognitive decline, and incident AD. Our overarching hypothesis is that AD disparities persist because racial/ethnic minorities have depleted resources to adapt to known AD risk factors and brain pathology and/or unique, yet unmeasured AD risk factors. Specific aims are to (1) identify risk factors relevant to minority populations and examine whether they predict advancing brain pathology, cognitive decline, and incident AD among African Americans or Hispanics, (2) determine which resources explain racial/ethnic differences in the impact of known AD risk factors on advancing brain pathology (i.e., brain resilience), and (3) determine which resources explain racial/ethnic differences in the impact of advancing brain pathology on cognitive decline and incident AD (i.e., cognitive resilience).