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

这项纵向研究的总体目标是确定种族/民族差异的新的、可改变的机制。 大约 2,000 名老年人的多种族群体中患有阿尔茨海默病 (AD)。发病率 与非西班牙裔白人相比，非裔美国人和西班牙裔的 AD 较高，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。 持续存在且无法解释的差异表明两种尚未得到充分检验的可能性：（1）已知 AD 风险因素在不同种族/民族中表现出不同的影响和/或 (2) 但未测量的因素会增加 AD 少数群体面临的风险。我们的研究团队发现了多个对认知能力有更强影响的因素 老年非裔美国人或西班牙裔人，包括抑郁症状和脑病理学 MRI 标记。 这些变量，加上血管健康状况不佳和教育/收入较低，对以下人群的影响可能较小 白人，因为多数群体的成员身份与社会环境资源相关， 促进复原力。在当前的提案中，复原力被概念化为优于预期的结果 给定的 AD 危险因素或脑部病理水平。本研究将探讨不同资源之间的差异 我们队列中的种族/民族（例如，感知的社会地位、教育质量以及对生活的看法） 结果是可控的）使用重复来提高 AD 致病途径中多个点的恢复力 三个时间点的 MRI 和认知评估。因为少数种族/族裔面临着独特的 压力源（例如文化压力、种族歧视），我们还将测试这些经历是否 影响大脑病理学、认知能力下降和 AD 事件的 MRI 标志物的进展。我们的 总体假设是，AD 差异持续存在是因为少数种族/族裔耗尽了资源 适应已知的 AD 风险因素和大脑病理学和/或独特的但未测量的 AD 风险因素。具体 目标是 (1) 识别与少数群体相关的风险因素并检查它们是否预测 推进非裔美国人或西班牙裔人的大脑病理学、认知能力下降和 AD 事件，(2) 确定哪些资源可以解释已知 AD 风险因素对人的影响的种族/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 先进的大脑病理学对认知衰退和 AD 事件的影响存在差异（即认知能力下降） 韧性）。

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).