The Voices of our Elders

研究项目：摘要 到2050年，65岁及以上的美国印第安人人数将增加两倍，达到1，624，000人， 85岁及以上的老年人将增加7倍，达到30万人。这些人口趋势引起了人们对人口的关注 阿尔茨海默病和相关痴呆（ADRD）的患病率及其前驱症状，轻度认知障碍， 以及对ADRD医疗保健的需求。美国印第安人也经历了ADRD的不成比例的负担 风险因素，如高血压和2型糖尿病。关于认知障碍和ADRD的现有数据， 美国印第安人的老年人仍然有限。此外，现有的少数关于美洲印第安人痴呆症的研究 仅限于美国中西部和西部。存在对能够估计、跟踪、 预防并最终治疗ADRD。我们还需要权衡适当的公共卫生的经济成本 对美国东部印第安人的干预。因此，我们建议第一批人口- 一项旨在系统地描述东部美洲印第安社区ADRD特征的研究 我们这项努力将是华盛顿州立大学、迈阿密大学和瓦巴纳基大学之间的合作 公共卫生，一个部落建立和指导的公共卫生区，为所有4个联邦承认的部落提供服务， 缅因州，统称为瓦巴纳基部落。大约有875名55岁及以上的美国印第安人居住在 在4个部落的服务提供领域，但对他们的认知功能或临床 ADRD或多发性认知障碍的患病率。我们将用部落卷邀请所有55岁的美国印第安人 和年龄较大的参与人群为基础的流行病学研究（n = 650，假设75%的参与 基于既往Wabanaki应答率），以评估认知功能和ADRD风险因素，并确定 可能有认知障碍或ADRD的人。我们还将进行病例对照验证研究， 一个参与者子集（n = 260），以验证我们的认知筛查结果与临床试验的结果。 诊断面谈是ADRD的金标准最后，我们将对当前的卫生经济学进行分析。 以及与ADRD相关的未来成本。我们的具体目标是：1）进行健康流行病学研究 以及ADRD和认知能力下降的生活方式风险因素，并筛查流行的ADRD和轻度认知能力下降。 Wabanaki部落55岁及以上成员中的损伤; 2）进行病例对照验证研究 将目标1的筛查结果与临床诊断访谈进行比较;以及3）使用目标1和2的数据， 估计当前和未来与ADRD和轻度认知障碍相关的直接和间接成本 发病率和治疗。我们的研究将为Wabanaki公共卫生提供宝贵的公共卫生数据， 美国印第安人全国，并有助于制定与ADRD相关的卫生干预措施， Wabanaki社区和其他美洲印第安人的需求。

RESEARCH PROJECT: ABSTRACT The number of American Indians aged 65 and older will triple to 1,624,000 by 2050, while the number of those aged 85 and older will increase 7-fold to 300,000. These demographic trends raise concerns about the population prevalence of Alzheimer’s disease and related dementias (ADRD) and its prodrome, mild cognitive impairment, and the need for health care for ADRD. American Indians also experience a disproportionate burden of ADRD risk factors, such as hypertension and type 2 diabetes. Available data on cognitive impairment and ADRD among American Indian elders remain limited. Furthermore, the few existing studies on dementia in American Indians have been limited to the midwestern and western US. There exists a need for studies that can estimate, track, prevent, and, eventually treat ADRD. We also need to weigh the economic costs of appropriate public health interventions for American Indians in the eastern half of the US. Accordingly, we propose the first population- based study designed to systematically characterize ADRD among American Indian communities in the eastern US. This effort will be a partnership between Washington State University, the University of Miami, and Wabanaki Public Health, a tribally founded and directed public health district serving all 4 federally recognized tribes in Maine, collectively known as the Wabanaki tribes. Approximately 875 American Indians aged 55 and older reside in the service delivery areas of the 4 tribes, yet nothing is known about their cognitive function or clinical prevalence ADRD or multiple cognitive impairment. We will use tribal rolls to invite all American Indians aged 55 and older to participate in a population-based epidemiologic study (n = 650, assuming 75% participation based on prior Wabanaki response rates) to assess cognitive function and ADRD risk factors, and to identify people with probable cognitive impairment or ADRD. We will also conduct a case-control validation study with a subset of participants (n = 260) to validate our cognitive screening results against the results of a clinical diagnostic interview, the gold standard in ADRD. Finally, we will conduct a health economics analysis of current and future costs associated with ADRD. Our Specific Aims are to: 1) Conduct an epidemiologic study of health and lifestyle risk factors for ADRD and cognitive decline, and screen for prevalent ADRD and mild cognitive impairment among Wabanaki tribal members aged 55 and older; 2) Conduct a case-control validation study comparing screening results from Aim 1 to a clinical diagnostic interview; and 3) Use data from Aims 1 and 2 to estimate current and future direct and indirect costs associated with ADRD and mild cognitive impairment morbidity and treatment. Our study will contribute invaluable public health data for Wabanaki Public Health and American Indians nationally, and contribute to the development of ADRD-related health interventions tailored to the needs of Wabanaki communities and other American Indian populations.