Racial Disparities in Alzheimer's Disease and Related Dementias: The Role of Blood Pressure Throughout Adulthood

阿尔茨海默病和相关痴呆症的种族差异：血压在整个成年期的作用

• 批准号: 9899176
• 负责人: Elizabeth Rose Mayeda
• 金额: $ 22.4万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9899176
• 关键词: Accounting; Address; Adult; Affect; African; African American; Age; Age of Onset; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Award; Base of the Brain; Biology; Biometry; Blood Pressure; Brain; California; Cardiovascular Diseases; Clinical assessments; Cognitive; Complement; Data; Development; Elderly; Epidemic; Epidemiology; Exposure to; Goals; Grant; Health; High Prevalence; Hypertension; Impaired cognition; Incidence; Individual; Lead; Link; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical Records; Mentorship; Methodology; Methods; Modeling; Neuropsychology; Outcome; Participant; Pathway interactions; Phase; Physical Examination; Population; Population Heterogeneity; Premature Mortality; Public Health; Records; Research; Research Training; Risk Factors; Role; Severities; Structure; Training; Universities; Vascular Diseases; brain health; career; checkup examination; clinical Diagnosis; cognitive change; cognitive function; cohort; dementia risk; disparity reduction; effective intervention; epidemiology study; experience; health disparity; indexing; innovation; middle age; mortality; neuroimaging; neuroimaging marker; novel; prevent; racial and ethnic disparities; racial disparity; skills; vascular factor

PROJECT SUMMARY Alzheimer’s disease and related dementias are a major public health burden and disproportionately affect African Americans. The mechanisms underlying this disparity are not well-understood, but elevated blood pressure could be key. Compared with whites, African Americans have higher prevalence, earlier age of onset, and greater severity of hypertension. Thus, older African Americans tend to have greater cumulative exposure to elevated blood pressure throughout adulthood than older whites. No prior research, however, has quantified the contribution of hypertension to racial disparities in Alzheimer’s disease and related dementias. There are significant methodological challenges to addressing this important question, including (1) measurement of cumulative exposure to elevated blood pressure from the age of onset of hypertension through late adulthood, (2) measurement of cognitive function in diverse populations, and (3) possible survival bias, which is likely to differentially affect African Americans. The scientific objective of this research plan is to identify the extent to which elevated blood pressure from mid- through late- adulthood mediates racial disparities in Alzheimer’s disease and related dementias. This project uses an innovative approach to examine this important question with existing data from two diverse Northern California cohorts: the University of California, Davis Aging Diversity Cohort and the Kaiser Permanente Northern California Multiphasic Health Checkup cohort, which links mid-adulthood physical examinations with long-term medical record information. Analyses will address the three major methodologic challenges outlined above by examining cumulative exposure to elevated blood pressure as measured at multiple points in adulthood, developing a novel neuroimaging-based brain health index in a diverse population, and quantifying the potential magnitude of survival bias using comprehensive midlife data to account for differential survival. This research plan is complemented by a training plan that builds on the applicant’s background in epidemiology and biostatistics and includes new training in (1) measuring and modeling cognitive function in diverse populations, (2) clinical assessment and diagnosis of Alzheimer’s disease and related dementias, (3) assessing brain health with neuroimaging, and (4) the biology of vascular disease relevant to Alzheimer’s disease and related dementias. The combined research and training plans will prepare the applicant for a successful independent research career focused on identifying modifiable determinants of Alzheimer’s disease and related dementias in diverse populations. The methodological challenges addressed in this project are common to many areas of research on disparities in aging and cumulative exposure to risk factors throughout the lifecourse for Alzheimer’s disease and related dementias.

项目概要 阿尔茨海默氏病和相关痴呆症是主要的公共卫生负担，对人类健康造成不成比例的影响 非裔美国人。这种差异背后的机制尚不清楚，但血液升高 压力可能是关键。与白人相比，非裔美国人患病率更高，发病年龄更早， 以及更严重的高血压。因此，年长的非裔美国人往往有更大的累积暴露 与年长的白人相比，整个成年期的血压升高。然而，之前的研究尚未量化 高血压对阿尔茨海默病和相关痴呆症种族差异的影响。有 解决这一重要问题所面临的重大方法论挑战，包括 (1) 衡量 从高血压发病年龄到成年晚期，累积暴露于高血压， (2) 不同人群认知功能的测量，以及 (3) 可能的生存偏差，这很可能 对非裔美国人的影响不同。该研究计划的科学目标是确定 中后期血压升高介导了阿尔茨海默氏症的种族差异 疾病和相关的痴呆症。该项目采用创新方法来研究这个重要问题 现有数据来自两个不同的北加州队列：加州大学戴维斯分校老龄化 多样性队列和 Kaiser Permanente 北加州多相健康检查队列， 将中年体检与长期病历信息联系起来。分析将解决 通过检查累积暴露于升高的血液中概述了上述三个主要方法学挑战 在成年期的多个时间点测量压力，开发一种新型的基于神经影像的大脑健康 不同人群的指数，并使用综合指标量化生存偏差的潜在程度 中年数据来解释生存差异。该研究计划由一项培训计划作为补充，该计划 以申请人的流行病学和生物统计学背景为基础，包括 (1) 方面的新培训 测量和建模不同人群的认知功能，(2) 临床评估和诊断 阿尔茨海默病和相关痴呆症，(3) 通过神经影像学评估大脑健康，以及 (4) 生物学 与阿尔茨海默病和相关痴呆症相关的血管疾病。综合研究和 培训计划将使申请人为成功的独立研究生涯做好准备，重点是识别 不同人群中阿尔茨海默病和相关痴呆症的可改变决定因素。这 该项目所解决的方法论挑战对于许多有关差异的研究领域来说是常见的 衰老和在整个生命过程中累积暴露于阿尔茨海默病及相关疾病的危险因素 痴呆症。