Psychological risk factors, quality of life, community, and brain aging in American Indians: The Strong Heart Study

项目摘要/摘要 在美国，每65秒就有一个人被诊断出患有阿尔茨海默病和相关痴呆症(ADRD)。 美国印第安人(AI)成人脑血管和ADRD相关合并症的负担比 他们的非西班牙裔白人同行。人工智能成年人也遭受不成比例的压力和创伤，以及 伴随而来的是高抑郁率。与之相关的是，人工智能成年人也有较高的物质滥用比率 对其他种族/民族群体。这些公共卫生问题随着人口老龄化而加剧，因为 压力、抑郁和物质使用与晚年的认知障碍有关。幸运的是， 健康相关生活质量(HRQOL)和社区联系的改善可能会改善这些 负面影响，尽管这些关联都没有在人工智能成年人中得到充分评估。作为减损 认知表现先于ADRD的发展，我们将确定ADRD的风险和保护因素 人工智能成人的认知表现，为潜在地绕过以后发展的预防策略提供信息 是ADRD的。心理危险因素和认知障碍之间的纵向关系需要 直接评估以检查随年龄增长而发生的临床变化的时间序列。另外， 测试人工智能成年人认知表现和痴呆症纵向关系的研究还缺乏。 已建立的纵向队列研究提供了评估可改变的风险和保护因素的机会 年迈的成年人，有多个数据收集。鉴于这些知识上的差距，我们的目标是测试 压力、抑郁和药物使用(酒精、烟草、处方类阿片)之间的纵向关系 与人工智能成年人的认知表现有关，以及HRQOL和社区连接性是否会调节这些 两性关系。我们的中心假设是，压力越大，抑郁程度越高，药物使用越多 尤其是误用，这三项都与较低的认知得分有关，而较好的HRQOL 而更好的社区连通性缓解了这些有害影响。使用心理测量学-稳健 NIH工具箱，我们还将测试和开发AI社区的标准化标准，使其能够 首次将AI认知数据与非西班牙裔白人、亚裔、非裔美国人和 西班牙裔成年人。我们建议的研究是与强心研究合作进行的，这是一项长达30年的老龄化队列研究 我是成年人。我们建议在后续检查(N=3,000)中收集这些心理和认知数据。 定义压力、抑郁、物质滥用、HRQOL和社区之间的联系；并定义 在一个普遍使用的、已建立的平台中的认知标准将为未来的公共卫生预防和 针对这些服务不足、负担过重的人群的治疗策略。

PROJECT SUMMARY/ABSTRACT Every 65 seconds someone in the US is diagnosed with Alzheimer's Disease and Related Dementias (ADRD). American Indian (AI) adults have greater burden of cerebrovascular and ADRD-related comorbidities than their non-Hispanic white counterparts. AI adults also suffer disproportionate stress and trauma, and concomitant high rates of depression. Relatedly, AI adults also have high rates of substance misuse compared to other racial/ethnic groups. These public health problems become exacerbated as a population ages, since stress, depression and substance use have been linked to cognitive impairment later in life. Fortunately, improvements to health-related quality of life (HRQoL) and community connectedness may ameliorate these negative impacts, although none of these associations have been fully evaluated in AI adults. As impaired cognitive performance precedes development of ADRD, we will determine risk and protective factors of cognitive performance in AI adults to inform prevention strategies to potentially circumvent later development of ADRD. Longitudinal relationships between psychological risk factors and cognitive impairment need to be directly evaluated to examine the temporal sequence of clinical changes that occur with aging. Additionally, research testing the longitudinal relationship with cognitive performance and dementia in AI adults is missing. Established, longitudinal cohort studies offer opportunity to assess modifiable risk and protective factors in aging adults, with multiple data collections. Given these gaps in knowledge, our objectives are to test the longitudinal relationship among stress, depression, and substance use (alcohol, tobacco, prescription opioids) with cognitive performance in AI adults, and whether HRQoL and community connectedness moderate these relationships. Our central hypothesis is that higher stress results in higher depression, more substance use and especially misuse, and that all three are associated with lower cognitive scores, whereas better HRQoL and better community connectedness moderate these deleterious effects. Using the psychometrically-robust NIH Toolbox, we will also test and develop normative standards for the AI community, making it possible for the first time to directly compare AI cognitive data with non-Hispanic white, Asian, African-American, and Hispanic adults. Our proposed study is in partnership with the Strong Heart Study, a 30-year cohort of aging AI adults. We propose to collect these psychological and cognitive data in a follow-up examination (N=3,000). Defining associations among stress, depression, substance misuse, HRQoL, and community; and defining cognitive standards in a commonly used, established platform will inform future public health prevention and treatment strategies for this underserved, overburdened population.