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

项目总结/摘要 在美国，每65秒就有一人被诊断出患有阿尔茨海默病和相关痴呆症（ADRD）。 美洲印第安人（AI）成年人的脑血管和ADRD相关合并症负担高于 他们的非西班牙裔白色同行。人工智能成年人也遭受不成比例的压力和创伤， 伴随着高抑郁率。与此相关的是，人工智能成年人的物质滥用率也很高， 其他种族/民族。这些公共卫生问题随着人口老龄化而加剧， 压力、抑郁和物质使用与以后生活中的认知障碍有关。幸运的是， 健康相关生活质量（HRQoL）和社区连通性的改善可能会改善这些问题。 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。为减值 认知表现先于ADRD的发展，我们将确定ADRD的风险和保护因素， AI成年人的认知表现为预防策略提供信息，以潜在地规避后期发展 的ADRD。心理危险因素和认知障碍之间的纵向关系需要 直接评估，以检查随衰老发生的临床变化的时间顺序。此外，本发明还 缺乏测试AI成年人认知表现和痴呆症纵向关系的研究。 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， 老年人，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、抑郁和物质使用（酒精、烟草、处方阿片类药物）之间的纵向关系 AI成人的认知表现，以及HRQoL和社区连通性是否会调节这些 关系。我们的核心假设是，压力越大，抑郁程度越高， 尤其是误用，所有这三种都与较低的认知评分相关，而较好的HRQoL 而更好的社区联系则缓和了这些有害影响。使用心理测量学上的 此外，我们还将测试和开发人工智能社区的规范标准， 首次将人工智能认知数据与非西班牙裔白色人、亚洲人、非洲裔美国人和 西班牙裔成年人我们提议的研究是与强壮心脏研究合作进行的，该研究是一项30年的老龄化队列研究， 成年人。我们建议在随访检查中收集这些心理和认知数据（N= 3，000）。 定义压力、抑郁、物质滥用、HRQoL和社区之间的关联; 在一个常用的、已建立的平台上的认知标准将为未来的公共卫生预防提供信息， 为这些服务不足、负担过重的人群提供治疗策略。

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.