Alzheimer's Disease and Related Dementias and Cognitive Impairment

项目1摘要 与年龄相关的痴呆的负担，包括阿尔茨海默病和相关痴呆(ADRD)， 在非洲大部分地区仍然研究不足，但有几个值得注意的例外。1-4到2040年，估计占80个国家中的70% 全球将有100万痴呆症患者居住在中低收入国家。5痴呆症是一种特殊的 这些国家的问题，如南非，预期寿命将大幅增加。 在几乎所有国家中，认知能力下降与家庭收入和 教育程度。10、11南非也不例外，与教育水平低和 终生的不利因素是巨大的。我们的长期目标是了解流行病学模式和 预测南非ADRD的公共卫生负担，以及确定哪些因素会减少 或增加ADRD风险。关于非洲健康和老龄化的续签申请：纵向研究 在INDEPTH社区(HAALSI)计划中，我们建议通过以下方式向这一目标迈出重要一步 在以人群为基础的HAALSI进行纵向认知和痴呆症相关评估 社区队列的成年人≥40岁。项目1与项目2(心脏代谢性疾病)合并 和3(艾滋病毒)，以优化目标。我们有与健康和退休研究相一致的认知测量方法 HAALSI队列中5,059名40岁的成年人≥的姐妹研究。我们提出以下目标： 目标1：了解ADRD的发病率和患病率以及轻度认知障碍 损害(MCI)。到05年，我们将用六年的时间在三波中进行三次认知评估 关于认知功能、死亡率跟踪以及临床和告密者评估的纵向信息。 这些数据将使我们能够(1A)确定全原因痴呆症和MCI的比率；以及(1B)评估 血管状况和艾滋病毒对全因痴呆症和MCI的影响，并计算归因风险。要做到这一点， 我们将使用神经心理学电池、临床检查和风险生物标志物提供的信息。 与艾滋病毒、抗逆转录病毒治疗(ART)和血管疾病有关。 目的2：确定影响认知功能下降和ADRD的社会和经济风险和复原力因素。 我们假设，教育程度和社交网络有助于老年人保持较高的认知水平 随着年龄的增长发挥作用(认知储备)。12-16我们确定社交参与是否来自网络 结构防止衰退。12，17-24我们检查与性别和年龄有关的缓和条件。 目的3：评价载脂蛋白E(APOE)与生物衰老相关标记物的相关性 伴有认知功能减退和ADRD的端粒。在一个2,000人的子样本中，我们将调查这些 遗传标记和ADRD，并确定风险以及与教育程度和ADRD的相互作用。

Project 1 Abstract The burden of age-related dementias, including Alzheimer’s disease and related dementias (ADRD), remains understudied in much of Africa, with a few notable exceptions.1-4 By 2040, an estimated 70% of the 80 million people with dementia globally will reside in low and middle income countries.5 Dementia is a particular issue for these countries, such as South Africa, where life expectancies are expected to rise dramatically.6-9 7-9 Within virtually all countries, cognitive decline has shown strong disparities with household income and educational attainment.10, 11 South Africa is no exception and the associations with low levels of education and lifelong disadvantage are substantial. Our long-term goal is to understand the epidemiologic patterns and projected public health burden of ADRD in South Africa, as well as to identify factors that either reduce or increase ADRD risk. With this renewal application for the Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community (HAALSI) Program, we propose to take a major step towards this goal by conducting longitudinal cognitive and dementia-related assessments in HAALSI , a population-based community cohort of adults ≥40 years of age. Project 1 is integrated with Projects 2 (Cardiometabolic Disease) and 3 (HIV) to optimize goals. We have cognitive measures harmonized with the Health and Retirement Study and sister studies for the HAALSI cohort of 5,059 adults ≥40 years of age. We propose the following aims: AIM 1: Obtain information on the incidence and prevalence of ADRD as well as mild cognitive impairment (MCI). By year 05, we will have three cognitive assessments over three waves with six years of longitudinal information on cognitive function, mortality follow-up and clinical and informant assessments. These data will permit us to (1A) identify rates of all-cause dementia and MCI; and (1B) evaluate impacts of vascular conditions and HIV on all-cause dementia and MCI and calculate attributable risk. To accomplish this, we will use information from our neuropsychological batteries, clinical examination, and biomarkers of risk related to HIV, antiretroviral therapy (ART), and vascular disorders. AIM 2: Identify social and economic risk and resilience factors affecting cognitive decline and ADRD. We hypothesize that educational attainment and social networks help older adults maintain high cognitive functioning as they age (cognitive reserve).12-16 We determine whether social engagement drawn from network structures protects against decline.12, 17-24 We examine moderating conditions related to gender and age. AIM 3: Evaluate associations of Apoliprotein E (APOE) and markers of biological aging related to telomeres with cognitive decline and ADRD. In a subsample of 2,000 we will investigate the role of these genetic markers and ADRD and identify risks and interactions with educational attainment and ADRD.