Alzheimer's Disease and Related Dementias (ADRD) prevalence in American Samoa

摘要 阿尔茨海默病和相关痴呆症（ADRD）影响着超过570万美国人和超过3500万人 国际吧土著居民，包括美洲印第安人、阿拉斯加原住民、夏威夷原住民和太平洋原住民 岛民越来越关注ADRD及其前驱状态，轻度认知障碍（MCI）， 这些条件日益对他们的社区产生重大影响。尽管这些人群在文化上 不同的和地理上分散的，他们有一个共同点，即高患病率的ADRD风险， 因素土著人口的预期寿命在过去50年中增加了， 65岁以上人口的增加。这些不断变化的人口统计数据使ADRD可能更加明显， 社区，然而，为这些人群服务的医疗保健系统没有为患者做好准备， 与ADRD相关的照顾者、社会和经济负担。不幸的是，同样是这些社区， 卫生知识普及和有限的研究准备需要解决日益严重的ADRD问题。位于 美属萨摩亚位于南太平洋的中心，是美国唯一位于赤道以南的领土。2020年美国 人口普查记录了49，710名居民，其中11，025人（4.1%）年龄超过50岁。目前，没有已知的 记录萨摩亚人口中ADRD患病率的研究。我们的首要目标是建立 在我们以前的工作，测试新的方法，以提高ADRD素养和研究准备，提高检测 ADRD，并建立在一个新生的研究基础设施，进行重要的表型和基因型 在美属萨摩亚的ADRD特征。我们的具体目标是：（1）测试ADRD知识，健康 识字，研究准备和确定ADRD的弹性和脆弱性因素，以及认知状态， 在我们的概率样本中，使用文化适应工具，对981名50岁以上的萨摩亚人进行概率样本，（2） 使用NIA的统一数据集（UDSv3.0）在我们的概率样本中进行黄金标准评估 阿尔茨海默病研究中心计划确定MCI和ADRD的基于人群的患病率， 协调，数据共享，并与其他组进行比较，和（3）交叉验证金标准痴呆症 利用遗传学的评估（即，ApoE）和血浆淀粉样蛋白-Tau-神经元损伤/神经变性（ATN） 框架（例如，A β 40、A β 42、p-tau、NFL、GFAP）生物标志物，并与 其他种族/族裔群体的信息。 缺乏相关的临床和规划知识阻碍了临床医生，科学家， 在美属萨摩亚，政府、政策制定者和社区努力缩小ADRD差距。我们的短期目标是 确定ADRD患病率，并研究美国ADRD的弹性和脆弱性因素 萨摩亚，并与其他调查人员共享资源。我们的长期目标是促进未来的研究工作， 在美属萨摩亚增加准确和早期诊断，扩大获得保健的机会，并改善保健结果。

ABSTRACT Alzheimer’s disease and related dementias (ADRD) affects over 5.7 million Americans and over 35 million people worldwide. Indigenous populations including American Indians, Alaskan Natives, Native Hawaiians and Pacific Islanders are increasingly concerned about ADRD and its prodromal state, mild cognitive impairment (MCI), as these conditions increasingly exert a major impact on their communities. Although these populations are culturally diverse and geographically dispersed, they share in common a high prevalence of well-established ADRD risk factors. Life expectancies in indigenous populations have increased over the past 5 decades resulting in a 3-fold increase in people over the age of 65. These changing demographics have made ADRD potentially more visible to communities, however the healthcare systems that serve these populations are unprepared for the patient, caregiver, social, and economic burdens associated with ADRD. Unfortunately, these same communities have low health literacy and limited research readiness needed to address the growing problem of ADRD. Situated in the heart of the South Pacific, American Samoa is the only U.S. territory located south of the equator. The 2020 U.S. Census recorded 49,710 residents, with 11,025 (4.1%) of the population over age 50. Currently, there are no known studies that document ADRD prevalence within the Samoan population. Our overarching OBJECTIVE is to build upon our prior work, test novel approaches to increase ADRD literacy and research readiness, improve detection of ADRD, and build upon a nascent research infrastructure to conduct important phenotypic and genotypic characterization of ADRD in American Samoa. Our SPECIFIC AIMS are: (1) Test ADRD knowledge, health literacy, research readiness and determine ADRD resilience and vulnerability factors, and cognitive status in a probability sample of 981 Samoans age 50+ using culturally adapted instruments in our probability sample, (2) Conduct Gold Standard evaluations in our probability sample using the Uniform Data Set (UDSv3.0) from the NIA Alzheimer’s Disease Research Center program to determine a population-based prevalence of MCI and ADRD for harmonization, data sharing, and comparison to other groups, and (3) Cross-validate Gold Standard dementia evaluations with genetic (i.e., ApoE) and plasma Amyloid-Tau-Neuronal Injury/Neurodegeneration (ATN) framework (e.g., A 40, A42, p-tau, NFL, GFAP) biomarkers in our probability sample and compare to information available for other racial/ethnic groups. The dearth of relevant clinical and programmatic knowledge hamstrings efforts by clinicians, scientists, policymakers, and communities to reduce ADRD disparities in American Samoa. Our short-term goal is to determine ADRD prevalence and study resilience and vulnerability factors contributing to ADRD in American Samoa and share resources with other investigators. Our long-term goal is foster future research efforts to increase accurate and early diagnosis, expand access to care, and improve health outcomes in American Samoa.