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、可修改的种族/民族差异机制 阿尔茨海默病(AD)在大约2,000名老年人的多种族队列中。的发病率。 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“常见疑点”：传统社会经济指标和血管健康。 持续的和无法解释的差异暗示了两种尚未得到很好研究的可能性：(1)已知 AD风险因素在不同种族/民族之间表现出不同的影响，和/或(2)但未测量的因素会增加AD 少数族裔面临的风险。我们的研究团队已经确定了在以下几个因素中具有较强认知影响的因素 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标记物。 这些变量，加上糟糕的血管健康和较低的教育/收入，可能对 白人，因为多数群体的成员资格与社会环境资源有关， 促进韧性。在目前的提案中，韧性被概念化为好于预期的结果 已知AD危险因素或脑病理水平。这项研究将考察不同地区的资源如何不同 我们队列中的种族/民族(例如，感知的社会地位、教育质量和对生活的感知 结果是可控的)使用重复序列在AD致病途径中的多个点促进韧性 三个时间点的核磁共振和认知评估。因为少数族裔面临着独特的 压力因素(例如，文化适应压力、种族歧视)，我们也将测试这些经历是否 影响脑部病理、认知功能减退和AD事件的MRI标志物的进展。我们的 最重要的假设是，AD差异持续存在，因为种族/民族少数人耗尽了资源 以适应已知的AD风险因素和脑病理和/或独特的、但未测量的AD风险因素。特定的 目的是(1)确定与少数族裔人口相关的风险因素，并检查它们是否能预测 在非裔美国人或西班牙裔美国人中推进脑病理、认知能力下降和阿尔茨海默病事件(2) 确定哪些资源可解释已知AD风险因素对以下方面的影响的种族/民族差异 推进大脑病理学(即大脑复原力)，以及(3)确定哪些资源可以解释种族/民族 进展性脑病理对认知功能减退和阿尔茨海默病事件(即认知功能障碍)影响的差异 恢复力)。

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).